Using History and Accomplishments to Plan for the Future

Using History and Accomplishments to Plan for the Future

A Summary of 15 Years in Agricultural Safety and Health, and Action Steps for Future Directions

Funding SponsorsAgricultural Safety and Health Network AgriSafe NetworkCarle’s Center for Rural Health and Farm Safety John Deere FoundationEastern Washington University, Center for Farm Health and SafetyThe Farm FoundationThe Great Plains Center for Agricultural Health*W.K. Kellogg FoundationNational Children’s Center for Rural and Agricultural Safety and HealthNational Institute for Occupational Safety and Health of the Centers for Disease Control and Prevention

(CDC Conference Grant Number R13/CCR518764-01 & PO#03DSR5-0012)**New York Center for Agricultural Medicine and HealthThe Occupational and Environmental Education and Outreach Center, Great Lakes Centers for

Environmental and Occupational Safety and Health, University of Illinois at Chicago School of PublicHealth

Pioneer Hi-Bred International, Inc.University of Illinois Extension University of Illinois at Urbana-Champaign, Office of Continuing EducationUniversity of Illinois at Urbana-Champaign, Department of Agricultural Engineering

Published 2003Agricultural Safety and Health NetworkTechnical Editor: Dave Mason, Publication Services, Inc.Graphic Production and Placement: Dorothy Evans, Publication Services, Inc.Public Health Review and Content: Natalie Roy, AgriSafe NetworkSubvening Camarilla: Mary Barrow and Barbara and Dave Opperman, YHWH Syndic

Recommended CitationPetrea, R.E. (Ed.). (2003). Using History and Accomplishments to Plan for the Future: A Summary of 15

Years in Agricultural Safety and Health and Action Steps for Future Directions. Urbana, IL: AgriculturalSafety and Health Network.

Photo Credits: AgrAbility Unlimited: pp. 10, 29, 30, 57, 76, 77; Donna Acklin: pp. 4, 46; Bob Aherin: p. 11;Ted Funk: pp. 32, 52; Robert Hornbaker: p. 18; Ken Koelkebeck: pp. 6, 54; Steven Lacey: pp. 19, 34, 37,38; Suzanne Mason: pp. 1, 5, 56; Chip Petrea: pp. 17, 33, 41, 48, 60.

Using History and Accompl ishments to P lan for the Future

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*This publication was supported by the United States Department of Health and Human Services, Centers for DiseaseControl and Prevention and the University of Iowa under Grant No. 5 U50 OH07748-02. Its contents are solely theresponsibility of the authors and do not necessarily represent the official views of United States Department of Healthand Human Services, Centers for Disease Control and Prevention or the University of Iowa.

**This publication was supported by the United States Department of Health and Human Services, National Institutefor Occupational Safety and Health of the Centers for Disease Control and Prevention under Grant No.R13.CCR518764-01 and PO#03DSR5-0012. Its contents are solely the responsibility of the authors and do notnecessarily represent the official views of United States Department of Health and Human Services, National Institutefor Occupational Safety and Health of the Centers for Disease Control and Prevention.

ForewordThe inspiration for this document arose out of general conversations among various individuals,specifically in discussions occurring at the annual meeting of the Agricultural Safety and HealthNetwork (ASH-NET) in 1998. This discussion centered on the process and efforts a decadeearlier that led to the publication of Agriculture at Risk: A Report to the Nation (Merchant et al.1989) and the contribution that document made in increasing investments and national effortsrelated to the safety and health of the nation’s family farms.

Discussions soon focused on the notable absence of a similar but current comprehensivedocument that looked at production agriculture and farmers, farmworkers, and their families.The passage of time and the changes within agriculture, and agricultural safety and health, sincethe publication of Agriculture at Risk called for another effort. Individuals’ thoughts then turnedto the possible uses to which a document relating current overall perceptions of the status ofagricultural safety and health, and concrete recommendations on future research and programneeds, could be put. Such a document could provide policymakers, public and private fundingagencies, and the general public with a convenient and realistic summary of recent progress in,the current status of, and informed projections on issues of concern within agricultural safety andhealth.

With these discussions and thoughts fresh in their minds, the participants in ASH-NETundertook to serve as the coordinating body for a proposed project. This three-year project“Using History and Accomplishments to Plan for the Future: A Summary of 15 Years inAgricultural Safety and Health, and Action Steps for Future Directions” would pull together thedifferent elements and technical expertise needed to produce a document aimed at refocusingattention on agricultural safety and health concerns.

These elements and expertise included agricultural safety and health researchers, educators, andprogram personnel; agriculture manufacturer and insurance association representatives; federal,state, and local government agency personnel; local medical, health, and emergency serviceproviders; and practicing farmworkers and farmers. Although considerable research to access andbetter understand the views of farmers and farmworkers toward specific agricultural safety andhealth topics has occurred, it was equally important to access these viewpoints in real time.

I am profoundly grateful to all those whose contributions made this document a reality. Theirexpertise, time, energy, and forgone work opportunities all contributed to the fundamental rolesthey served. All of us sincerely hope that this endeavor will make a meaningful contribution infurthering the safety and health needs of the farmers, farmworkers, and their families involved inproduction agriculture, upon whom we are critically dependent.

Chip Petrea, PhDExecutive Director, ASH-NET

A Summary of 15 Years in Agr icul tura l Safety and Heal th , and Act ion Steps for Future Direct ions

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Project Planning Committee

ASH-NET Participants

Bob Aherin, University of IllinoisPam Elkind, Eastern Washington UniversitySister Gail Grimes, Farmworker Association of FloridaJanet Ivory, New York Center for Agricultural Medicine and HealthSusan Jones, Western Kentucky UniversityTracy Keninger, Easter Seals of IowaBob McKnight, Southeast Center for Agricultural Health and Injury PreventionSuzanne Mason, Emory UniversityJohn May, New York Center for Agricultural Medicine and HealthMarge Niedda, El Comité de Apoyo a los Trabajadores AgrícolasTeresa Niedda, Farmworker Safety and Health InstituteChip Petrea, University of Illinois at Urbana-ChampaignKathy Pitts, Eastern Washington UniversityCJ Tyler-Watson, Eastern Washington University

Ad Hoc Advisory Participants

Kelley Donham, University of IowaBill Field, Purdue UniversityEric Hallman, National Institute for Farm SafetyDavid Hansen, Farm Safety 4 Just KidsDavid Hard, National Institute for Occupational Safety and HealthBarbara Lee, Marshfield Clinic, Marshfield, WisconsinShannon Lizer, University of Illinois Medical School–RockfordMurray Madsen, Deere and Co., RetiredDennis Murphy, Penn State UniversitySteve Olenchock, National Institute for Occupational Safety and HealthRisto Rautiainen, University of IowaSusan Reynolds, Progressive FoundationLorann Stallones, Colorado State UniversityDon Villarejo, Center for Rural Studies, Retired


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Entities Endorsing This Project and Its Activities

Center for Farm Health and Safety, Eastern Washington UniveristyCommunity Health Partnership of IllinoisFarm Safety 4 Just KidsFarmworker Health and Safety InstituteKentucky Partnership for Farm Family Health and Safety, Inc.Iowa’s Center for Agricultural Safety and HealthMigrant Clinicians NetworkNational Children’s Center for Rural and Agricultural Health and SafetyNational Institute for Farm SafetyNew York Center for Agricultural Medicine and HealthNorth American Agromedicine ConsortiumPenn State Agricultural Safety and Health


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Work Group Process Discussion LeadersChristine FreehillDave Hansen and Leslie NickelsTracy KeningerShannon LizerTeresa Niedda, Marge Niedda, and Richard MandelbaumCJ Tyler-Watson and Bob Aherin

Work Group Process Participants

FarmersJeff Anderson, WALori Anderson, WABrad Baugh, WAKaryl Baugh, WAEd Bell, INGary Erisman, ILChristine Freehill, ILMark Freehill, ILJennifer Felzien, COPaul Gunderson, NDAnne Harder, WALex Harder, WADan Littrel, NETammi Littrel NEBeth Mauer, PARichard Mauer, PACyndy Shinn, NEGary Shinn, NEBill Stutts, LATammie Stutts, LAHelen Tyler, WACJ Tyler-Watson, WA


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FarmworkersAspacio Alcántara, NYCarolina Almanza, FLRamona Alvarado, ILHerminia Arenas, CAAlfredo Bahena, FLCecilia Barros, CAFelipe Cabrera, NCMarta Duarte, CAJosé Manuel Guzmán, NJRichard Mandelbaum, NJAlicia Marentes, TXCarlos Marentes, TXTirso Moreno, FLOscar Munoz, ILMarge Niedda, NJTeresa Niedda, NJEduardo Ortega, NJPaula Placencia, CAAdan Jesus Quavez, NYAngelita Rodriquez, FLSalvador Rodriquez, WASalvador Villancana, NJ


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ContentsExecutive Summary: Recommendations and Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

Prologue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20Highlights of Progress in Agricultural Safety and Health . . . . . . . . . . . . . . . . . . . . . . . . . . . .21Current Status of Agricultural Safety and Health in the United States . . . . . . . . . . . . . . . . . . .24

Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24Emergency and Medical Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25Behavioral Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25Fatalities and Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26Illnesses and Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26Biotechnology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27Agricultural Safety and Health Professionals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28Recommendations and Strategies with Rationales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29Funding Recommendation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29

Recommendation 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29Recommendation 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33Recommendation 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37Recommendation 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41Recommendation 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43Recommendation 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46Recommendation 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52Recommendation 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57Recommendation 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60

Public Health Perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62Document Applicability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62Public Health Interfacing with Agriculture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71

Conference Presentations and Papers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71Other Citations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72Healthy People 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74National Occupational Research Agenda Priority Research Areas . . . . . . . . . . . . . . . . . . . .74

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75Conference Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75Consensus Work-Group Process Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75


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R E C O M M E N D A T I O N 1Develop a specific federal research and surveillance agenda with measurable goals and objectivesto reduce agriculture-related injuries, illness, and disease.

Strategies

A NIOSH should fund the development of goals and measurable objectives for agricultureproducers, workers, and their families. Following a model similar to Healthy People 2010, atask force representing various agricultural health and safety disciplines would direct thisinitiative.

B Associated with Strategy A would be the development of an agriculture-specific NationalOccupational Research Agenda (NORA) within Centers for Disease Control andPrevention/NIOSH.

C Federal agencies and the land grant universities should develop strategies to implement theNational Land Grant Research and Extension Agenda for Agricultural Safety and Health2003.

D Include occupational injury and illness reporting, with location of injury, as a supplement tothe annual National Health Interview Survey as an interim step until a mechanism to offsetdata omissions within current Bureau of Labor Statistics–based surveys can be implemented.

E DOL and NIOSH should coordinate the development, a comprehensive national nonfatalinjury surveillance system comparable to the Census of Fatal Occupational Injuries (CFOI)that would be directed at women, older farmers, immigrant and minority workers (byrace/ethnicity), the disabled, adult full- and part-time workers (both paid and unpaid), andcultural minorities for delineation of the extent of specific problems related to each of thesepopulations.

Executive Summary: Recommendations and Strategies

Funding RecommendationThe U.S. Congress should provide funding to the several federal agencies referenced—throughreallocation, redistribution, or additional, and as needed—for implementing both the research andnonresearch components of this report.

The impact of the many local, regional, state, and national private-sector contributions are recognizedand most significant to the cause of agricultural safety and health, and those will continue. Themagnitude and importance of the recommendations and strategies identified are mostly national in scopeand require national resource assistance, the better to serve as a foundation and partner to those private-sector contributions.


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R E C O M M E N D A T I O N 2Current funding for research and programming for special populations at risk within agricultureshould be continued.

Strategies

A USDA should continue funding through its Cooperative State Research, Education, andExtension Service (CSREES) for National AgrAbility and associated state programs as aconduit to collect and disseminate information on injury, illness, and disease effects withinagriculture and successful accommodation of those disabling conditions.

B Implement the specific recommendations relating to childhood agriculture injury preventionas produced by the National Children’s Center for Rural and Agricultural Health and Safety(Lee et al. 2002).

C Implement the specific recommendations relating to improving the working conditions ofmigrant and seasonal adolescent farmworkers as produced by the National AdolescentFarmworker Occupational Health and Safety Advisory Committee (Vela Acosta & Lee2001).

R E C O M M E N D A T I O N 3Strategies to improve the living and working environment of migrant and seasonal farmworkersshould be implemented.

Strategies

A Federal funding for migrant health clinics should be maintained with expanded assistance tothose clinics to assist in compiling surveillance data on diagnosis and treatment.

B Increase enforcement of current regulations relating to the current EPA Worker ProtectionStandard (WPS) and the Certification of Pesticide Applicators Standard (CAS).

C Evaluate components of the current EPA Worker Protection Standard (WPS) and theCertification of Pesticide Applicators Standard (CAS), in conjunction with local/regionalfarmworkers, to ensure that such training adequately reflects the actual conditionsexperienced by the workers.

D Evaluate the current protocols related to reporting agricultural chemicals, in conjunctionwith local/regional farmworkers, to ensure that the procedures are readily available tofarmworkers and conducted in a manner that farmworkers find effective.

E Federal agencies funding research and services for migrant and seasonal farmworkers shouldrequire that those workers, both men and women or their designated representatives, beactively engaged in the planning and implementation of proposal objectives as a criterion forfunding.


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R E C O M M E N D A T I O N 4Model agricultural safety and health programs related to health care services, professionaltraining, educating, and conducting applied research in community settings should be replicatedand evaluated to determine their effectiveness in other agricultural communities.

Strategies

A USDA should target the development of information, assessment, and assistance programsthat address underserved populations in ways that are culturally sensitive to the differencesamong populations and base such programs on the successes learned with the NationalAgrAbility program.

B NIOSH should revitalize the Agricultural Health Promotion System (AHPS) funding stream.Such funding could focus on combining lessons learned from previous (AHPS) funding withnew findings from successful models of community-directed interventions.

C NIOSH should target specific funding within the Centers for Agricultural Disease and InjuryResearch, Education, and Prevention (Ag Research Centers) to form advisory committees offarmers and farmworkers to develop protocols for using community assets to collaborativelyconduct technical, anthropological, and social science research within the agriculturalcommunities.


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R E C O M M E N D A T I O N 5Enhance collaborative efforts between professionals working in agricultural safety and health andprofessionals working in primary health care.

Strategies

A USDA should be allocated additional funds to designate a full-time national program leaderfor agricultural safety and health within the Cooperative State Research, Education, andExtension Service. Such a designation is not intended to supersede or replace currentlydelegated DOL, EPA, or OSHA oversight.

B In each state, USDA should fund a full-time state extension specialist in agricultural safetyand health with matching operating funds from the state. This position would collaboratewith the health specialist identified in strategy C below.

C In each state, NIOSH, HHS, or USDA should fund a full-time faculty position at acorresponding state university providing health professionals with matching operating fundsfrom the state. Utilizing the agromedicine model, this position would deal primarily withrural primary care and would work in collaboration with the state extension specialist inagricultural safety and health.

D USDA through the university-based extension system should facilitate collaboration ofprofessional organizations to provide for the continuing professional development ofagricultural safety and health professionals and primary care providers and other health careproviders on current issues related to the agricultural environment.


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R E C O M M E N D A T I O N 6Increase the capacity to provide rural emergency medical services, agricultural occupationalhealth services, mental health care, rehabilitation services, and education to the agriculturalcommunity.

Federal Strategies

A An interagency agreement between Department of Transportation/National Highway TrafficSafety Administration, Department of Homeland Security, Department of Health andHuman Services, and United States Department of Agriculture should be developed todesignate a single site with specific authority for administration and funding to ensure thatrural emergency services remain an integral part of national emergency service capabilities.

B The Rural Emergency Medical Service Training and Equipment Assistance Program,authorized in the Health Care Safety Net Amendments of 2001 (P.L. 107-251), shouldreceive funding appropriations as designated through the U.S. Department of Health andHuman Services and administered by the Health Services Resources Administration.

C The National Institute of Mental Health/Office of Rural Mental Health Research and theNational Advisory Committee on Rural Health and Human Services/Office of Rural HealthPolicy/Health Resources and Services Administration should work collaboratively indeveloping a National Center for Agricultural Behavioral Health to facilitate the interface ofresearch and service delivery relating to addictions, mental health, and social psychologicaldistress found in the agricultural setting.

D Target musculoskeletal disorders for CDC/NIOSH funding and support for expanded fieldintervention and prevention in cooperative partnerships with farmers and farmworkers.

State Strategy

E State university–based Cooperative Extension offices should establish formal relationshipswith state Public Health Departments and state Environmental Protection Agency offices tofacilitate the formation of a task force to provide pesticide prevention programs for farmers,migrant/seasonal farmworkers, and their families, as well as rural residents.

Local Strategy

F Recruitment and retention of rural emergency volunteers should be the topic of in-depthresearch at the community/squad level in order to understand the problem. Subsequentplanning and action should be based on the findings of that research.


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R E C O M M E N D A T I O N 7Enhance determinant research that examines how various risks and protective factors affect thehealth of the agricultural community.

Strategies

A NIOSH, NIEHS, and EPA should continue funding investigations related to improvedassessments of indoor air exposure for confinement workers and better defineRecommended Exposure Limits (RELs, NIOSH) and associated Permissible Exposure Limits(PELs, OSHA) to reflect any dose-response relationship found.

B The EPA should target additional technical, epidemiological, and exposure assessments todefine the emission elements responsible for specific community effects found with largeconfinement animal production.

C BLS and NIOSH should collaborate to allocate funding, similar to NIOSH Sentinel EventNotification System for Occupational Risks (SENSOR) projects, toward protocols toimprove the delivery of standard medical surveillance to agricultural workers, includingimproved reporting and tracking of occupational injury and illness.

D NIOSH and privately and publicly owned corporations should increase efforts toward thestandardization and improvement of biomarker assessments relating to agricultural illnessand disease.

E EPA and privately and publicly owned corporations should target funding for research toestablish causal linkages or dose-response relationships between chronic illness and pesticideexposure; critically important is research into potential endocrine disruptor effects ofpesticides.

F The National Cancer Institute should target funding for long-term research on the possibleassociation of nitrate in drinking water with cancer risks that addresses the inherentweaknesses of currently available case-control and ecological studies.


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R E C O M M E N D A T I O N 8Apply to the fullest extent current advances in engineering and application technology to reducefatalities, injuries, illness, and disease in the agricultural community.

Strategies

A Continue dissemination and evaluation of the recommendations to reduce tractor-relatedinjuries and deaths produced at the Tractor Risk Abatement and Control policy conference(Donham et al. 1997), particularly with those audiences whose collaboration will be neededto enact said recommendations.

B USDA, through the Cooperative State Research, Education, and Extension Service (CSREES)and the university-based extension system, should take the lead in facilitating the applicationof industry-wide, low-cost ergonomic interventions and commodity-specific standardizationof improved ergonomic tools, using successes such as those in the NIOSH publicationSimple Solutions: Ergonomics for Farm Workers as a model.

C American Society of Agricultural Engineers and Society of Automotive Engineers, throughvoluntary standards, should facilitate the use of universal design concepts to foster thedevelopment of high-quality and task-specific materials for use in safety and healthequipment for the disabled.

R E C O M M E N D A T I O N 9Investigate the safety and health impacts of the annual exemptions from federal agencyenforcement of regulations applied to agriculture.

Strategies

A Form a task force composed of individuals representing farm organizations, farm employerorganizations, farmers, farmworkers, appropriate researchers in pertinent fields, agriculturalhealth care providers, and applicable governmental agencies to evaluate the overall impactof two important exemptions now applied to agriculture. NIOSH funds channeled throughthe Ag Research Centers would cover the travel and lodging of task force representatives.The two exemptions to be evaluated include:

1. “U.S. Department of Labor should exclude from OSHA protection all agricultural workersin agricultural operations employing 10 or fewer non-family workers within the past 12months, and having no temporary labor camps in the last 12 months. The U.S. Departmentof Labor has interpreted this to mean that whenever a farm operation has more than 10workers employed on any 1 day, the operation is subject to OSHA regulation” (Runyan).

2. “Permit Required Confined Spaces (PRCS) and under OSHA’s guidelines, can only beentered by developing and following a plan addressing the hazards found in that space. Thecharacteristics of a PRCS, are found under OSHA’s Confined Space Standard (29 CFR1910.146) but family farms are exempted from the PRCS standard” (Steffen).


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PrologueOne of the fundamental objectives of this project was the integral inclusion of all of those whoactually face the hazards associated with production agriculture on a daily basis. As much as wewould have liked to include all of the variety of individuals this encompasses, the diversity of thefarmers and migrant/seasonal farmworkers who could participate is gratifying, as they representmany of the types of farming and farm work environments found across the United States. Theseparticipants tell us that they were informed by the presentations and discussions, and werelikewise appreciative of the opportunity to inform and relay their personal experiences to others.The consensus process that followed the conference was necessary to flesh out basic differences inopinion and to reach the degree of understanding that is reflected throughout this document.

Such inclusion served to allow one-on-one and group interactions that are not commonlyavailable, particularly to those working directly in production agriculture. All involved sufferfrom limited exposure to the difficulties faced by others, though in many cases the difficulties aresimilar. This unfamiliarity may be due to a lack of previous interaction or little publicity ofothers’ conditions within the groups’ separate realms. And for those speaking a language otherthan English, there are natural communication barriers and transportation difficulties thatpreclude direct, meaningful interaction. Concerning health and safety in particular, there aremany specifics that are common to all involved. However, there are also items unique to eachgroup (farmers or workers), and these need to be noted.

Certain agricultural safety and health concerns were at once seen as common to both farmers andmigrant/seasonal farmworkers. An excellent example is the concern about the lack of adequatemedical services in rural areas and the high cost of those services that can be found. This problempoints to the need for better training of health professionals in common agriculturalenvironments and increased awareness of the lesser-understood migrant/seasonal farmworkerhealth issues.

Other common laments were vulnerability to outside forces for the prices received for goods(commodities) or services (labor) and the high cost and limited availability of health insurance.Both farmers and farmworkers have very little control over the prices they receive. Farmers mayuse contracting or forward pricing but have little influence on the prices offered. Farmworkersmay try organizing, but changes in season and locale, as well as the lack of a legally sanctionedright to organize, make sustaining improvements difficult. Both groups face difficulties inobtaining health insurance at costs that are affordable, even if it is available. Although state orfederal programs may be available, many family farms face eligibility problems related to assetswhile farmworkers face time restrictions within any one location. Farmers or spouses may takeoff-farm jobs to obtain such insurance, but farmworkers, due to restrictions of movement,language, education, or documentation, lack that option.

Many farmers and farmworkers feel that this lack of control over prices received can have adirect relationship on safety and health and needed services, and they are receiving support. TheUnited States Department of Agriculture in 1997 appointed the National Commission on SmallFarms to review the status of small farms and determine a course of action for the USDA. Thiscommission challenged the USDA “to be more cognizant of how we produce an abundant, safefood supply; to recognize the full diversity of contributors to this goal; to ensure that the marketaccommodates all producers fairly; and to recognize different needs and contributions of thediverse farm operations in this country” (USDA 2000).

The commission report, A Time to Act, states:

“As farm size and absentee ownership increase, social conditions in the local communitydeteriorate. . . . Communities that are surrounded by farms that are larger than can beoperated by a family unit have a bi-modal income distribution, with a few wealthy elites,a majority of poor laborers, and virtually no middle class. The absence of a middle classat the community level has a serious negative effect on both the quality and quantity ofsocial and commercial service” (p. 20).

Thus health and safety issues cannot be separated from the larger political and economiccontext. Inadequate levels of health and safety for both farmworkers and farmers is butone symptom in an overall agricultural economy in which small producers (the “familyfarmers”) are being squeezed out of the market, and farmworkers’ wages and conditionsare stagnant or declining. (Mandelbaum)

Other agricultural safety and health issues required some discussion to bring to light the commonbasis and the unique differences. Many workers on farms, be they full-time or seasonal, acceptcertain inherent working conditions and responsibilities within the work place and within specificfieldwork because they are the same ones incurred by the farmer/owner/employer. In other cases,even though the worker voluntarily offers his or her services for hire, there is an additional“power” issue involved. Migrant/seasonal farmworkers are by nature temporary in terms ofemployment and locality. Language barriers, dependence on employer housing and/ortransportation, and immigration status may all contribute to the worker having little “power” tocontrol his or her situation. An additional stress is the need to maximize earnings during theshort season. The entire season for work in certain areas may be only five or six months. If thefarmworker is migrant and is following the work as plants reach a critical stage (e.g., pickingfruit), there is even less time in which the worker will be in one location. The short duration ofstay makes workers particularly vulnerable not only to natural difficulties such as weather, butalso to any forced requirements such as length of workday or hourly pay. Such pressures canincrease workers’ sense of having little power over their predicament.

This perceived power imbalance can lead to a situation of refraining from complaining about,much less reporting, safety or health violations. These situations can arise either in the formalworkplace or in the residences located at or near the workplace. This situation can also lead to afarmworker’s continuing to work following an injury or illness because doing otherwise wouldmean lost wages. There are many conscientious production agriculture employers who seek tomeaningfully address this issue. However, we should not use examples of the conscientious in anattempt to mitigate the human impact of those who are not.

Another issue about which meaningful information and personal realities were exchanged relatedto migrant/seasonal farmworkers’ experiences with the H-2A Guestworker visa program [LaborCertification Process for Temporary Agricultural Employment in the United States (H-2AWorkers)]. This program allows agricultural employers to fill labor shortages with temporaryforeign workers. One of the fundamental concepts in the H-2A Guestworker program is that anemployer who applies for permission to hire temporary foreign workers may not offeremployment terms that “adversely affect” the wages and working conditions of similarlyemployed U.S. farmworkers (Mandelbaum; Niedda). Discussion of the H-2A program led directlyinto the topic of undocumented workers.


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The general initial reaction to this issue was “How does this apply to this particular safety andhealth effort?” It was pointed out that the program is perceived to discriminate against womenand older farmworkers by a preference for younger, male workers. Instances occur under theprogram where women are paid less than men for the same work and older workers receive lessas they work more slowly, rather than not work at all. The economic needs of the extendedfamily may lead to children also working for hire. It was noted that children, women, olderworkers, and minorities have already been designated as “special populations at risk” foroccupational health concerns. Combined with the aforementioned “power” issues, languagebarriers, housing locations, and transportation concerns, this led to acknowledgment thatworkers contributing to production agriculture under the program face numerous anxietiesrelated to their safety and health. Regardless of personal views on policy, enforcement, ornecessity, the farmworkers themselves spoke powerfully on the topic.

This section closes with two submissions: “The Disadvantages of the UndocumentedFarmworkers” and “Thoughts from a Family Farmer.” Because one of the primary goals of thisproject was the inclusion of individuals who routinely face agricultural hazards, it naturallyfollowed that space should be provided for representatives of farmworkers and farmers to speakfor themselves. Please read their earnest words closely.


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The Disadvantages of the Undocumented FarmworkersPiece written by Aspacio Alcántara (CITA)

Undocumented workers do not have the same legal protections.

They work under the fear and threat of being incarcerated, fined, or deported as if they werecriminals.

Their legal status makes them vulnerable to the abuses of crew leaders and growers who threatento call the INS (immigration).

They are afraid to make complaints or report violations in regard to labor laws, like if they getsick or poisoned from working in a field sprayed with pesticides.

They are denied the opportunity to obtain a driver’s license to be able to drive cars, trucks,tractors, or other vehicles that are used in agriculture.

Regarding their health and that of their families, they do not have the opportunity to acquirehealth insurance or seek the necessary medical attention in case of illness.

They do not qualify for unemployment or disability benefits.

They have many problems in obtaining credit, bank accounts, in order to rent or buy a homewhere they can live with dignity.

Immigration status directly affects the education of their children, who also do not qualify forhigher education.

For lack of immigration documents, many doors are closed for farmworkers, whose only crime isto work to survive poverty and produce wealth for this country. This profoundly affects the self-esteem of these farmworkers, who are treated like third-class workers, very similar to slavery ofthe past.

All this and much more, like the danger and humiliation of crossing the Border, are the obstaclesthat our fellow farmworkers confront day after day, doing the work that the citizens of thiscountry do not want to do.

For all these reasons, we consider the theme of health and safety in agriculture in the UnitedStates be seen and understood as an integralpart of the migratory status of farmworkers.

Farmworker Groups Represented

CATA—El Comité de Apoyo a los TrabajadoresAgrícolas

CITA—Centro Independiente de los TrabajadoresAgrícolas

FHSI—Farmworker Health and Safety InstituteFWAF—Farmworker Association of FloridaMWUC—Men & Women United in the

Community


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Thoughts from a Family FarmerChristine Freehill, Strawn, Illinois

Economic Issues

Farmers want to “do the right thing” for their families, communities, employees, and land;however, the costs are often prohibitive.

It is difficult to include “non-essential” items in a farmer’s budget because of the uncertainty ofincome from year to year.

Operational costs in agriculture rise disproportionately to income, which makes including safetyand health expenses difficult if not impossible for many farmers.

Social Issues

“Farmers” are rapidly becoming several different groups with vastly different interests—olderfarmers just trying to survive until retirement; young, aggressive farmers utilizing technology toimplement agriculture on a large scale; part-time farmers that have full-time off-farm employment;and niche/boutique farmers that produce specialty products on small acreage. Each of these groupshas different attitudes about safety and has different needs regarding safety and health.

There is a perception by the non-farming population that farming is a quaint way of life. This isnot true. Farming is big business (no matter what the scale of the individual farmer).

Farmers breathe the air, drink the water, and live near the fields they farm. We are as interested inprotecting these resources as our non-farming neighbors. The perception that farms arerampaging our natural resources out of greed or laziness is unfair and only serves to widen therift between agricultural and non-agricultural interests.

Physical/Psychological Issues

Farmers don’t want others in their community to know when they are experiencing financialproblems for fear of losing leased ground or losing the opportunity to lease more ground iflandlords become aware of their problems. This decreases the likelihood they will seek help from

outside resources and increases stress levels.

Farmers and farm families suppress feelingsof stress and anxiety to avoid appearingweak. This prevents people from realizingthey need help until it is too late.

The physical demands and hazardousexposures in agriculture are oftenunrecognized by primary care providers.

Primary care providers often don’t recognizethe potential for hazardous exposures in thefamily members of farmers.


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MethodsThe project “Using History and Accomplishments to Plan for the Future: A Summary of 15 Yearsin Agricultural Safety and Health, and Action Steps for Future Directions” was envisioned withthree complementary and overlapping phases: a conference in the first year, a work-group processin the second year, and development of a draft document for review and publication of afinalized document in the third year. The effort constitutes a consensus process, with the objectiveof representing as many of the diverse views of agriculture as possible and combining academicrigor and personal, practical perceptions to inform participants in reaching agreement on therecommendations put forth.

The conference, “An Agricultural Safety and Health Conference: Using Past and Present to MapFuture Actions,” was designed as a forum for those with expertise in the field of agriculturalsafety and health to present their thoughts, perceptions, and findings on current pertinent topicsthrough presentations and discussions. This expertise included researchers, educators, andprogram personnel; agriculture industry and organization representatives; federal, state, and localgovernment agency personnel; and practicing farmworkers and farmers. This base of knowledgeset the stage for the work-group discussions in the second year.

The consensus work-group process was designed as a mechanism to secure reflective input fromindividuals representative of the diverse participants in agriculture. Six work groups were formed,each with a designated facilitator (Delbecq et al. 1975), to examine three key questions (Donhamet al. 1997; Meyers 2001) that would help guide discussions:

1. What are the current gaps, needs, and oversights in current activities related toagricultural safety and health?

2. What are your suggestions on how to address the current gaps, needs, andoversights in activities related to agricultural safety and health?

3. What do you see as barriers to implementing your suggestions for addressing thecurrent gaps, needs, and oversights in activities related to agricultural safety andhealth?

The initial work-group sessions were followed by scheduled teleconferences and other interactiveformats to provide all participants with summaries from other work groups on which to baseadditional discussion. This phase concluded with a face-to-face meeting to address unresolvedquestions and comments that arose during the process.

The draft document developed in the third year used the information and discussions from theconference and the response summary from the work-group process as the content base. Afterinitial review and comment from the project planning committee, the draft document wascirculated to all conference participants as well as numerous organizations, agencies, and otherinterested parties for additional review and comment. The finalized document was thendistributed to all for endorsement.


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Highlights of Progress in Agricultural Safety and Health

The following is an incomplete compilation of specific initiatives and programs that haveoriginated since the 1989 publication of Agriculture at Risk: A Report to the Nation* up to the“Using Past and Present to Map Future Action” conference. This selective listing is aimed atshowing the breadth of activities, both public and private, that constitute generally acknowledgedprogress in the realm of agricultural safety and health. Of course, any such partial listing willobscure many other meaningful and worthwhile actions that have taken place. Toward those, noslight is intended.

• Significant, and often underestimated, private-sector and not-for-profit initiatives for fundingand provision of in-kind services to assist others in agricultural safety and health programmingand in leveraging funds for such programs and research, equipment, materials, and guidance.

• Establishment of the National AgrAbility program to assist disabled farmers and their familieswith funding provided by the U.S. Department of Agriculture (USDA) through land grantuniversities working in conjunction with nonprofit disability-related organizations.

• The primary role of the National Institute for Occupational Safety and Health (NIOSH) infocusing intramural and extramural research and education programs related to agriculturalsafety and health. Extramural funding includes 10 Centers for Agricultural Disease and InjuryResearch, Education, and Prevention (Ag Research Centers) based at institutions around thecountry.

• The Environmental Protection Agency’s announcement of major revisions in the WorkerProtection Standard and subsequent authorization of full implementation of the standard.

• Establishment of the National Children’s Center for Rural and Agricultural Health and Safetyas a focus of NIOSH extramural agricultural safety and health research and educationprogramming.

• Increased support by NIOSH through selected NIOSH Education and Research Centers(ERCs) for agricultural safety and health academic preparation of students and in-servicetraining of professionals.

• Continuation and expansion of programs such as the South Carolina Agromedicinepartnership of health and agricultural professionals and the Iowa Center for Agricultural Safetyand Health’s Agricultural Occupational Health Training Program for local community healthcare providers.

• The Pesticides and National Strategies for Health Care Providers initiative, sponsored by theU.S. Environmental Protection Agency (EPA), the U.S. Department of Health and HumanServices (HHS), the U.S. Department of Labor (DOL), and the USDA.


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*A substantive review of the progress made on specific recommendations in Agriculture At Risk: A Report to theNation by initiative category (Legislative, Research, Occupational Health and Safety Delivery, Education, andCoalition) can be found in a peer-reviewed article in the Journal of Agricultural Safety and Health (Donham & Storm2002) based on their paper prepared as a part of this project (Donham).

• Publication by the American Society of Agricultural Engineers of the Journal of AgriculturalSafety and Health (JASH), which is indexed or abstracted in 12 agricultural, environmental,governmental, medical, and professional sites, including Medline and Agricola; and theHaworth Medical Press publication of the Journal of Agromedicine (JOA), which is indexed orabstracted in 19 agricultural, environmental, governmental, medical, and professional sites,including Agricola and the Cumulative Index to Nursing & Allied Health Literature.

• NIOSH funding for state surveillance of occupational disease and injuries and the developmentof model population-based programs targeting farmers, farmworkers, and farm families.

• The Agricultural Health Study, undertaken as a collaborative effort with the National CancerInstitute (NCI), the National Institute for Environmental Health Sciences (NIEHS), and theEPA to follow a cohort of farmers for at least 10 years to document specific outcomes ofagricultural exposures.

• Funding by NIOSH, NIEHS, EPA, NCI, and National Institute of Mental Health of programsto enable research into specifics of agricultural chemical toxicity, organic dusts and gases, andassociated environmental hazards.

• W. K. Kellogg Foundation funding of the Agricultural Safety and Health initiative, whichincluded 11 demonstration projects involving collaborative efforts between institutions andcommunities at the local, regional, and state levels.

• Targeted funding sources, such as NIOSH Community Partners for Healthy Farming andNIEHS Environmental Justice: Partners in Communication, to foster the development andevaluation of public/private/not-for-profit community efforts assisting farmers, farmworkers,and their families.

• National initiatives such as Progressive Farmer Farm Safety Day Camps and Farm Safety 4 JustKids, facilitating and guiding local collaborative efforts to address childhood agricultural safetyand health concerns.

• Provision by agribusiness (i.e., equipment, chemical, insurance, seed, feed, grain, insurance,media, health, and medical services) and its local representatives of incentives and assistancewith specific activities such as Rollover Protective Structures (ROPS) at cost-of-productionprices, personal protective equipment, educational programs, and health screenings.*

• Education and training programs for agricultural safety and health professionals such as theNational Institute for Farm Safety’s Professional Improvement seminars and courses and theNational Safety Council’s National Education Center for Agricultural Safety.

• Publication of various agricultural safety and health texts and references addressing the scopeand depth of occupational injury, illness, and disease hazards; prevention; treatment; andaccommodations for disabling conditions.

• NIOSH establishment and maintenance of the National Agricultural Safety Database as aWorld Wide Web–based resource.


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*A nice summary of private-sector perspectives related to childhood agricultural injury prevention is available from thePurdue University Agricultural Safety and Health Program (Purdue University 1997).

• USDA establishment of the NCR-197 Committee on Agricultural Safety and Health Researchand Extension, with the purpose of utilizing the land grant system’s research and extensioncapacity in conjunction with the expertise of those living and working in agriculture to reducework-related injury, illness, death, and property loss.

An important caveat to this listing of accomplishments is that regardless of progress made, muchattention is still needed on all fronts. To this end, the recommendations and strategies that followrepresent an effort to provide some direction to continue the progress made and to fosteradvances in several areas that are in need of further consideration and additional examination.


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Current Status of Agricultural Safety and Health in the United States

The conference presentations and attendant discussions provided a snapshot of currentperceptions relevant to agricultural safety and health. These presentations and discussions alsoprovided insight into many of the changes that continue to impact production agriculture. Thefollowing summary provides a glimpse of the issues noted.

DemographicsThe total number of farms is now approximately 2.2 million, and concentration withinproduction agriculture continues. The increasing concentration is evident not only in the growthof the average size of farms, but also in the fact that 20% of the farms enumerated producealmost 100% of the renewable fuels, 90% of the renewable fibers, and 80% of the foods orfoodstuffs (Gunderson). This concentration can also be seen in management practices in dairy,cattle, poultry, and especially in swine (Thu). Hispanic farmers represent the fastest-growingcategory of new farmers (work groups). A recent seven-year average reveals that approximately2.25 million full-time workers are employed in production agriculture. However, the most recentestimates indicate that the number of full-time workers has fallen below 2 million for the firsttime (Hard).

The number of women farm operators and mangers continues to increase, with 23.1% of farmoperators and managers and 19% of farm workers being female. Overall, the percentage ofwomen participating in agriculture is increasing faster compared with other business segments.The percentage of women farm operators and managers listing agriculture as their primaryoccupation, 45%, is now nearly the same as the percentage of men, 50.1% (McCoy).

The proportion of farmers age 55 and older continues to rise, now 61%, while the percentage offarmers less than 35 years of age continues to fall, now 8% (Hernandez-Peck). Older farmerscontinue to be at highest risk in terms of fatalities from tractor overturns (Hard).

Specific emphasis has been made in recent years on increasing the amount and quality of dataavailable on special populations at risk (children, women, the elderly, minorities, disabled,selected others) within production agriculture. However, compared with white farm populations,the imbalance in the quantity of data available for these groups is extreme. This is particularlytrue for racial or ethnic minorities such as African-American, Hispanic, and various populationsfrom Asia and the Caribbean. This imbalance applies also to cultural minorities based on socio-religious beliefs and practices, such as the Amish and the Old Order Mennonites, and toindividuals with various physical or mental disabilities (Earle-Richardson; Jones; Field).

The total number of hired farmworkers has decreased but has recently stablized, and theexpectation is that the number of hired farmworkers will begin to increase. As opposed to thetrend of increasing age found with owners, hired farmworkers tend to be younger males whospeak a primary language other than English, though women and families are also prevalent(Mandelbaum; Gunderson; Earle-Richardson). This projected increase is partially due to adecrease in the number of nonpaid agricultural workers, who now comprise the largestpercentage of agricultural workers and many of whom are family members (Stallones; Shutske).


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It is estimated that there are from 2.2 to 2.5 million farmworkers laboring within productionagriculture. The lack of consistent definitions both among federal agencies and between studiesand the environment within the work is performed makes precise enumeration difficult(Stallones). This difficulty is aggravated by the grouping of different ethnicities or races within anoccupational group (e.g., migrant and seasonal farmworker), thus discounting ethnicity/race as afactor in individual worker health (Earle-Richardson).

The number of farm operators with physical disabilities continues to increase, while theincreasing mean age has led to a higher prevalence of disabling due to age-related diseases. Themost frequently occurring disabling conditions are spinal cord injuries and amputations (Field).As many as 288,000 agricultural workers between ages of 15 and 79 have a disability that affectstheir ability to perform one or more essential functions of life (Willkomm).

Emergency and Medical ServicesA higher percentage of rural residents are over 65 (18% vs. 15%) and a higher percentage ofrural elderly live in poverty (21% vs. 12%) compared with their urban counterparts. At the sametime, this rural, elderly, and low-income population is primarily dependent on fire and emergencymedical service departments made up of volunteers, who provide the only services for 80% of theU.S. geographic area and for fully 25% of the U.S. population (Erisman a). This condition isaggravated by the increased rural population (Gunderson). This situation naturally highlights theincreasing scarcity of local medical services of all kinds—primary care providers, emergencyrooms, clinics, ambulances, and emergency medical technicians—for all rural residents, eitherfarm or nonfarm, but particularly those whose principal language is other than English (Erismanb; Lighthall; Rosmann). A primary concern for those individuals who do volunteer is training.Funding for emergency medical services training, which was established by federal funding, is nolonger available through that source (Erisman b).

Behavioral HealthThere has been an increased understanding of the unique mental health issues related toagriculture. The risk of psychological injuries, emotional and mental health impairments,relationship issues (including abuse), and substance misuse is similar to the risk of physical healthinjuries and illnesses: The likelihood of these undesired events increases with age, economicstress, and exposure to multiple distressing events at once. If there is one general conclusion thatcan be reached, it is that producing food and fiber as a way of life is associated with an increasedlikelihood of behavioral health perils. One direct indicator of this is the marked differencebetween the general population and farmers in suicide attempts per successful suicide (the generalpopulation has almost twice as many attempts per success). Another indicator is that thedifference in negative mental health indicators between farmers and nonfarmers (with farmerindicators more negative) is greater than that found between rural dwellers and urban dwellers.In addition, specific information on behavioral health issues of farmworkers is almost totallylacking (Rosmann).


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Fatalities and InjuriesOn the nation’s farms in 1997 there were 705 work-related fatalities and 50,544 work-relatedinjuries (Runyan). The fatality rate per 100,000 workers in agricultural production is 25.8,compared with an all-industry fatality rate of 5.0. A specific segment of agricultural production,crop production, has an even higher rate at 36.5 (Hard). Research for more accurate fatality dataon women in agriculture is slowly occurring (McCoy). More specific research on minority farmowners and farmworkers is occurring especially for African-American farmers in the South andHispanics in the Southeast and the West. However, most of this research is geared toward men,with little data for women available (Earle-Richardson).

On U.S. farms, 104 individuals less than age 20 die each year. The fatality rate for workers ages15–19 is the same as that for workers ages 20–54, over twice the average rate for all industries.In terms of specific age categories, 40% of the deaths among males occur between the ages of 15and 19, while 40% of the deaths among females occur at age 4 or less (Lee; Vela Acosta).

Tractor overturns continue to cause the highest percentage of farm work-related fatalities (Hard).As many as 32% of agricultural deaths are tractor related, amounting to 270 occupationalfatalities, 264,651 restricted work days, and 10,939 lost-time injuries per year (Myers). Theincreased size of machinery combined with the longer public roadway transportation distancesdue to larger farm size can be correlated to road collisions involving farm equipment, which nowranks as the second highest cause of farm fatalities (Redding).

In terms of nonfatal agricultural injuries overall, 61% occurred to the operator of the farm or tofarm family members. The most common source of injuries are machinery and livestock, at 19%,with livestock handling being the specific work activity most frequently performed (28%) (Hard).As for nonfatal agricultural injuries to youth, 32,800 occur each year among workers less thanage 20 years. During this same year, males will account for 80% of all injuries, and the majorityinjured will be white. The most common fatality cause will be “farm machinery includingtractor,” at 36%. During this same year, specific data for migrant and seasonal youth farmlaborers indicate that 3,900 will be injured (Lee; Vela Acosta).

Other injuries also commonly occur on farms. Common, chronic back pain occurs in 26% offarmers and ranchers overall and affects 71% of swine producers. Arthritis of the hips and kneesis routinely found in dairy farmers. In California nurseries, 49% of injuries result from sprainsand strains, with 46% affecting the back specifically (Kirkhorn). Given the deficiencies in data, itis assumed that injuries in the farmworker population are undercounted. According to availabledata, the one-year prevalence of back pain in production agriculture is 1/2 times higher than theaverage in other industries (Chapman).

Illnesses and DiseasesIndividuals working in the general agricultural environment face an increased prevalence ofseveral acute and chronic respiratory diseases, with exposures to a wide range of respiratorytoxins in concentrations higher than those found in other industries. In addition, though confinedanimal feeding operations (CAFO) may provide for improved working conditions overall, suchfacilities can also increase worker exposure to organic dust, bioaerosols, toxic gases, andendotoxins (found in organic dusts) (Kirkhorn; Von Essen). Research also shows that neighbors


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of CAFOs report specific symptoms similar to those of workers within the facilities themselves(Thu). Regional differences are also found, with acute and chronic effects of inorganic dust onthe respiratory system greater in dry-climate agricultural regions (Kirkhorn).

Several cancers are of concern within the production agricultural setting. Lip cancer, multiplemyeloma, non-Hodgkin’s lymphoma, and prostate, skin, brain, and soft-tissue sarcomas all havedemonstrated associations with farming, but research findings remain inconsistent, with noconsensus on causality. Several cancers have been associated with specific exposures to pesticide-related compounds, and those with the most direct exposures, especially farmworkers andpesticide mixers and applicators, may be at higher risk (Kirkhorn).

Non-cancer pesticide-related difficulties may take the form of skin irritation, eye irritation,fatigue, and headaches. However, chronic exposures have been associated with reproductiveproblems, particularly lymphomas and reproductive organ tumors. The effects in females includemiscarriage, preterm delivery, and infertility. Adverse results have also been shown in ecologicstudies with males. In addition, acute organophosphate poisonings have well-described effects onthe nervous system, with additional burdens found with mixtures of pesticides. Another criticalconcern is the potential endocrine disruptor effect of pesticides (Kirkhorn; Fuortes).

As with fatality data, a problem with specific data on farmworker illnesses is undercounting. Theareas of concentration on illness data are also similar to the case for fatalities. One detailed studyindicated that 66% of farmworkers reported musculoskeletal pain in the past year and 22%reported chronic eye irritation. Of those responding, over 30% had never been to a doctor orclinic and 50% had never been to a dentist or an eye care specialist. Most carried a geneticpredisposition toward certain diseases such as diabetes and high rates of obesity, increasing long-term risks of heart disease, hypertension, and stroke (Lighthall).

Nitrate contamination of surface water as well as groundwater supplies has been documented inmany areas of the United States. This contamination has been found in concentrations exceedingone-half of the 10 parts per million level allowed by the EPA. Exposure to nitrate per se is not ofparticular concern, but nitrate can be reduced in the body to (N-nitroso compounds (NOCs)),which are some of the strongest known carcinogens. While there is concern regarding long-termexposure to higher levels of NOCs, data is lacking to address the possible association of nitratein drinking water with cancer risk. There are also potential non-cancer health effects from directnitrate toxicity, such as “blue baby syndrome.” Firm relationships between these non-cancerhealth effects and nitrate are difficult to establish due to many confounding factors (Weyer).

Noise-induced hearing loss can be found in over 50% of the farming population. Many commonpieces of equipment such a tractors, vacuum pumps, and feed-unloading machinery areassociated with decibel levels above those deemed safe according to OSHA standards (Kirkhorn).

Biotechnology Biotechnology has been both hailed as a majorscientific breakthrough and condemned as aprecursor of dread. While work has been done on risk assessments related to food safety andenvironmental protection concerning new products of biotechnology, little has been done inrelation to the effects of this technology on the workers involved in producing and processing thenew organisms. Thus, there are diverging opinions on its use. There are indications that the use


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of biotechnology may reduce exposure to traditional risks found in agriculture. The advantagesclaimed include fewer workers riding bean bars, fewer workers walking beans holding sharptools, reduced persistency of Round Upcompared with the chemical it replaces, and reduced useof insecticides with the planting of Bt Corn. However, others claim that there is an overall lack ofaccurate information regarding genetically modified organisms and their consequences for boththe consumer and worker, that genetic engineering can lead to “super weeds” that actuallyrequire more applications of stronger herbicide to kill them, that new allergens and toxins mayunwittingly be produced, and that the true health implications of the genetically engineeredorganisms are not investigated before approval for use is granted (Shutske; Niedda).

Agricultural Safety and Health ProfessionalsOne of the important movements within agricultural safety and health has been the cross-education and cross-training of safety professionals and medical/health professionals in the broadrange of issues, concerns, and perspectives related to agriculture and its workers. Most safetyprofessionals have undergone some exposure to aspects of human health in order to betterperform their function in prevention and amelioration of undesirable incidents within theworkplace. Medical/health professionals have recently received exposure to safety and preventionconsiderations outside that provided by public health education to be more informed about theunique exposures found within the agricultural environment. The cross-training movement hasprovided for more broadly informed and better-educated individuals in the two realms bothseparately and collectively. However, the ability of the “safety” field to continue to contribute tothis cross-training is a matter of concern.

A review of the graduate programs approved by the Accreditation Board for Engineering andTechnology, Inc. (ABET), the organization that certifies safety programs, reveals no Ph.D.programs in safety, and few master’s programs (ABET 2003). A review of academic programsoffered by the CDC/NIOSH-funded Education and Research Centers reveals no safety-specificacademic programs offering safety training related to engineering or occupational healthadvanced degrees. This is relevant, as the mission of these NIOSH centers includes support of“academic degree programs and research training opportunities in the core areas of industrialhygiene, occupational health nursing, occupational medicine, and occupational safety, plusspecialized areas relevant to the occupational safety and health field” (NIOSH 2003c). Reasonsfor the decline in graduate safety programs include (1) a strong employment market for thosewith baccalaureate safety degrees, (2) lack of incentives by employers for employees to pursuegraduate safety degrees, (3) lack of faculty with advanced safety degrees—particularly Ph.D.s—tostaff graduate programs, and (4) the fact that other graduate programs—particularly those thatare health related—often integrate nonspecific safety content in their curricula in the belief that itwill provide adequate preparation for their graduates. These factors added together are resultingin numbers below the threshold necessary for universities to maintain or initiate programs toproduce safety graduates per se with advanced degrees. Thus, a pipeline for people with Ph.D.s—or, to a lesser extent, M.S. degrees—in safety no longer exists.

It is necessary to consider the potential consequences of the loss of a cadre of safety subjectmatter professionals to work alongside the extension, medical, health, education, and communityprofessionals to address the issues found in the agricultural environment. (work groups).


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R E C O M M E N D A T I O N 1Develop a specific federal research and surveillance agenda with measurable goals and objectivesto reduce agriculture-related injuries, illness, and disease.


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Recommendations and Strategies with Rationales

Funding RecommendationThe U.S. Congress should provide funding to the several federal agencies referenced—throughreallocation, redistribution, or additional, and as needed—for implementing both the research and non-research components of this report.

The impact of the many local, regional, state, and national private-sector contributions are recognizedand most significant to the cause of agricultural safety and health, and those will continue. Themagnitude and importance of the recommendations and strategies identified are mostly national in scopeand require national resource assistance, the better to serve as a foundation and partner to those-privatesector contributions.

Strategies

A NIOSH should fund the development of goals and measurable objectives for agricultureproducers, workers, and their families. Following a model similar to Healthy People 2010, a taskforce representing various agricultural health and safety disciplines would direct this initiative.

B Associated with Strategy A would be the development of an agriculture-specific NationalOccupational Research Agenda (NORA) within Centers for Disease Control andPrevention/NIOSH.

C Federal agencies and the land grant universities should develop strategies to implement theNational Land Grant Research and Extension Agenda for Agricultural Safety and Health 2003.

D Include occupational injury and illness reporting, with location of injury, as a supplement tothe annual National Health Interview Survey as an interim step until a mechanism to offsetdata omissions within current Bureau of Labor Statistics–based surveys can be implemented.

E DOL and NIOSH should coordinate the development of a comprehensive national nonfatalinjury surveillance system comparable to the Census of Fatal Occupational Injuries (CFOI)that would be directed at women, older farmers, immigrant and minority workers (byrace/ethnicity), the disabled, adult full- and part-time workers (both paid and unpaid), andcultural minorities for delineation of the extent of specific problems related to each of thesepopulations.


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Strategy

A Much headway has been made in agricultural safety and health, but there remain no stated goals or specific objectives to use in measuring and evaluating progress. Healthy People 2010

is designed to reach two overarching goals (1) to increase the quality and years of healthy life and(2) to eliminate health disparities. Healthy People 2010 outlines 10 leading health indicators,defines 28 focus areas that can apply to any or all of the indicators, and lists 467 specificobjectives [see Office of Disease Prevention and Health Promotion (2003) for a listing ofindicators and focus areas]. At least 22 of the focus areas can be said to apply directly toagricultural safety and health. However, even given this level of specificity, much informationrelated to agricultural health remains obscure (Donham).

An example of a leading health indicator is Environmental Quality. A focus area directlyassociated with this indicator is Environmental Health, which contains 30 specific objectives touse as benchmarks to measure improvement. An example of a specific objective is “8-13. Reducepesticide exposures that result in visits to a health care facility.”

The American Association of Poison Control Centers is the data source for this objective and issaid to cover approximately 93% of the population (Office of Disease Prevention and HealthPromotion 2003a).

However, given agricultural circumstances such as migrant and seasonal labor with associatedlanguage difficulties and power perceptions, use of family member labor, overall lack of healthcare access, and the many citations of the lack of quality baseline data (Earle-Richardson;Fuortes; Kirkhorn; Lighthall; Mandelbaum; McCarthy; Niedda; Vela Costa; Weyer), it would beexpected that agriculture pesticide exposure incidents are underreported. As NIOSH has beengiven the lead in the Healthy People 2010 Occupational Safety and Health focus area and ischarged generally with research into agricultural safety and health issues, it is natural for NIOSHto facilitate this group. It is recognized that quality baseline data for measuring progress isscattered or missing, and this will need to be addressed as part of the goal and objective process.

Strategy

B In April 1996 NIOSH and its partners unveiled the National Occupational Research Agenda (NORA), a framework to guide occupational safety and health research—not only for NIOSH

but for the entire occupational safety and health community. Before NORA, no national researchagenda existed in the field of occupational safety and health, and no research agenda in any fieldhad captured such broad input and consensus. NORA consists of 21 priority areas categorizedunder three main headings: Disease and Injury (eight priorities), Environment and Workforce(five priorities), and Tools and Approaches (eight priorities). Unfortunately, as is the case with theHealthy People 2010 objectives, many of the priority areas that specifically relate to agriculturalsafety and health use data that is ill defined, partial and scattered, or missing altogether. It makessense to coordinate the specific research priorities of an agricultural safety and health NORAwith the broader goals and objectives of an agricultural Healthy People initiative.

Strategy

C The NCR-197 Committee on Agricultural Safety and Health Research and Extension was established in 2000 with the goal to make more effective use of “the land grant system’s

research and extension capacity in cooperation with the expertise of those who live and work inagriculture to reduce work-related injuries, illness, death, and property loss” (NCR-197). Thiscommittee of 18 land grant universities selected a subcommittee to develop a draft of researchand extension priorities. A series of drafts were prepared and circulated to the full committee andselected administrators for review, comment, and revision. The finalized draft document,including the 12 priority recommendations, was circulated to all land grant institutions and wasapproved for distribution and implementation by a portion of those institutions.


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National Land Grant Research and Extension Agenda for Agricultural Safety and Health 2003 (NCR-197),

The research and extension priorities are not intended to be all inclusive of every potentialsignificant topic that could be addressed by the land grant system. Nor should the list of topicsbe used to restrict ongoing or future research and extension initiatives of individual land grantinstitutions and their staffs. The list does, however, reflect an effort to identify broad areas ofneeded research and a modest attempt to prioritize them. It is recognized that additional topicsmay surface due to the introduction of new production and processing practices and pressurefrom public opinion.

1. Sensors and Guarding Systems2. Operating Agricultural Equipment on Public Roads3. Agricultural Confined Spaces 4. Emerging Technologies5. Human Factors Engineering and Design6. Management of Agricultural Emergencies7. Livestock Handling and Housing Systems8. Public Policy Issues9. Capital and Management Intensive vs. Family Labor Intensive Operations

10. Fire Detection and Suppression11. Agricultural Safety Education and Training12. Special Populations and Enterprises

Strategy

D The current BLS National Health Interview Survey uses a fairly small sample and would contain wide confidence intervals for specific occupations such as farmers or workers in

production agriculture. However, the addition of occupational injury and illness reporting thatincludes location of injury would add data that is not now collected. And the Bureau of LaborStatistics does not include family farms or farms that employ 10 or fewer people in their injurysurvey because these farms can not be required to maintain the records for injury/illnessreporting. The latter circumstance arises from the annual legislative limitations on enforcement ofOccupational Safety and Health Act regulations (Hard; Runyan; work groups). It is necessary toincrease the data collected under the current instrument while a better collection apparatus isdesigned that would more fully describe the actual situation.

Strategy

E The Census of Fatal Occupational Injuries, part of the Bureau of Labor Statistics occupational safety and health statistics program, provides the most complete count of fatal

work injuries available. The program uses diverse state and federal data sources to identify,verify, and profile fatal work injuries. Information about each workplace fatality (occupation andother worker characteristics, equipment being used, and circumstances of the event) is obtainedby cross-referencing source documents, such as death certificates, worker’s compensation records,and reports to federal and state agencies. This method ensures that counts are as complete andaccurate as possible (BLS 2003).


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As stated previously, gaps in data collection remain. Recognition of these gaps has fosteredspecific emphasis in recent years on increasing the amount and quality of data available onspecial populations at risk (children, women, the elderly, minorities, the disabled, selected others)within production agriculture. However, compared with white farm populations, the imbalancein the quantity of data available is extreme. This imbalance particularly applies to racial or ethnicminorities such as African-American, Hispanic, and various populations from Asia and theCaribbean. This imbalance applies also to cultural minorities based on socio-religious beliefs andpractices, such as the Amish and the Old Order Mennonites, or to those with various physical ormental disabilities (Earle-Richardson; Field; Hernandez-Peck; Jones; McCoy; Rosmann;Willkomm). The recommendation for a more directed CFOI seeks to modify a current effort,even given its deficiencies, until a more complete program can be initiated.


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R E C O M M E N D A T I O N 2Current funding for research and programming for special populations at risk within agricultureshould be continued.

Strategies

A USDA should continue funding through its Cooperative State Research, Education, andExtension Service (CSREES) for National AgrAbility and associated state programs as aconduit to collect and disseminate information on injury, illness, and disease effects withinagriculture and successful accommodation of those disabling conditions.

B Implement the specific recommendations relating to childhood agriculture injury preventionas produced by the National Children’s Center for Rural and Agricultural Health and Safety(Lee et al. 2002)

C Implement the specific recommendations relating to improving the working conditions ofmigrant and seasonal adolescent farmworkers as produced by the National AdolescentFarmworker Occupational Health and Safety Advisory Committee (Vela Acosta & Lee2001).


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Strategy

A The AgrAbility project was created to assist people with disabilities employed in agriculture. The project links the Cooperative Extension Service at a land grant university with a private

nonprofit disability service organization to provide practical education and assistance thatpromotes independence in agricultural production and rural living. While the USDA administersthe AgrAbility project through CSREES, the project funds both a National AgrAbility programand several state AgrAbility programs. It is estimated that over 250,000 agricultural workersbetween the ages of 15 and 79 have a disability that affects their ability to perform one or moreessential tasks. AgrAbility programs seek to offer assistance while also documenting the scopeand needs of this population (Field; Willkomm).

Referring once more to Healthy People 2010, an identified focus area is Disability and SecondaryConditions. This focus area contains the specific objective “6-12. (Developmental) Reduce theproportion of people with disabilities reporting environmental barriers to participation in home,school, work, or community activities” (Office of Disease Prevention and Health Promotion2003b).

The term Developmental in objective 6-12 indicates that insufficient data is available to provide abaseline on which to measure progress. Such being the case for the disability population ingeneral, it is not surprising that an estimate is all that is available for those in agriculture. Thenumber of farm operators with physical disabilities continues to increase, while the increasingmean age has led to a higher prevalence of disabling due to age-related diseases. The AgrAbilityproject should continue its successful state and locally directed efforts in assisting those withdisabilities in agriculture.

Strategies

B ANDC The prevention of injuries and fatalities to children as a result of agricultural production remains a top priority. With two major broad-based initiatives

undertaken to identify the particulars related to childhood agriculture injury prevention, thecurrent project seeks to complement and supplement those initiativess rather than redo theirindividual efforts. Presentations and work-group process discussions reiterated many details ofchildhood agriculture injury prevention, such as age-appropriate tasks and developmentallyappropriate tasks, as well as confirming the overall goals and strategies identified in thoseprocesses and their published documents. A short summary of each project follows.

Strategy

B Childhood Agricultural Injury Prevention: Progress Report and Updated National Action Plan from the 2001 Summit (Lee et al. 2002)

Key PointsNumerous discussions were held with core advisors and multiple stakeholders throughout thecourse of planning, implementing, and completing tasks associated with the 2001 Summit onChildhood Agricultural Injury Prevention. Several key points continued to emerge, warrantingspecial attention since they have applications to all the proposed future strategies.

• When considering childhood agricultural injury prevention strategies, we must acknowledgethat education alone is insufficient. A multi-faceted approach, of which education is just onecomponent, is warranted if we are serious about reducing the toll of childhood agriculturalinjuries.

• Wherever possible, systematic evaluation should be applied to existing and new programs andevaluation results should drive program modifications.

• Innovative strategies should be pursued that reflect agriculture’s diversity of farm laborers,commodities, production methods, communities, and external forces, such as today’s globaleconomy.

• Concentrated efforts should be made to enable farm families, rural schools, farm andcommunity groups, agribusinesses, and agricultural training programs to plan and implementthese recommendations.


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• Successes and failures regarding research and program activities should be broadlycommunicated in order to maximize progress toward achieving our goals.

• There is a continued need for a coordinating center that will keep this momentum movingforward.

Strategy

C Migrant and Seasonal Hired Adolescent Farmworkers: A Plan to Improve Working Conditions (Vela Acosta & Lee 2001)

The National Adolescent Farmworker Occupational Health & Safety Advisory Committee wasconvened by the National Children’s Center for Rural and Agricultural Health and Safety todevelop recommendations for research and intervention actions to prevent occupational injuriesand diseases among hired migrant and seasonal adolescent farmworkers. Committee members’expertise and published literature as of July 2001 was gathered to develop recommendationsaimed to:

• Reduce risk of occupational injuries and diseases resulting from exposures to agricultural workenvironments.

• Promote knowledge and skills in agricultural health and safety for hired migrant and seasonaladolescent farmworkers.

• Encourage constructive, prosperous, and healthy beginnings to work life for hired adolescentfarmworkers.

Stakeholders interested in promoting the occupational health and safety of adolescentfarmworkers developed twelve recommendations with the following goals:

1. Identify profiles of hired adolescent farmworkers employed in production agriculture acrossthe United States.

2. Identify occupational risks that are potentially unique and specific to hired adolescentfarmworkers.

3. Plan, implement, and evaluate interventions to eliminate or minimize occupational health andsafety risks of hired adolescent farmworkers.

In striving to prevent occupational injuries and diseases among adolescent farmworkers, everyeffort should be made to incorporate and highlight established best practices.


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R E C O M M E N D A T I O N 3Strategies to improve the living and working environment of migrant and seasonal farmworkersshould be implemented.


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Strategies

A Federal funding for migrant health clinics should be maintained with expanded assistance tothose clinics to assist in compiling surveillance data on diagnosis and treatment.

B Increase enforcement of current regulations relating to the current EPA Worker ProtectionStandard (WPS) and the Certification of Pesticide Applicators Standard (CAS).

C Evaluate components of the current EPA Worker Protection Standard (WPS) and theCertification of Pesticide Applicators Standard (CAS), in conjunction with local/regionalfarmworkers, to ensure that such training adequately reflects the actual conditionsexperienced by the workers.

D Evaluate the current protocols related to reporting agricultural chemicals, in conjunctionwith local/regional farmworkers, to ensure that the procedures are readily available tofarmworkers and conducted in a manner that farmworkers find effective.

E Federal agencies funding research and services for migrant and seasonal farmworkers shouldrequire that those workers, both men and women or their designated representatives, be activelyengaged in the planning and implementation of proposal objectives as a criterion for funding.

Strategy

A The lack of consistent definitions among federal agencies, studies conducted, and the environment within the work is performed makes precise enumeration of workers in general

difficult. Such difficulty is aggravated by the grouping of different ethnicities or races within anoccupational group (e.g., migrant and seasonal farmworker), thus discounting ethnicity/race as afactor in individual worker health (Earle-Richardson; Lighthall; Niedda; Stallones; work groups).

The HHS Health Resources and Services Administration operates through four bureaus. Three ofthose bureaus and their missions are as follows: The Bureau of Primary Health Care (BPHC)serves to provide primary health care to medically underserved people, the Maternal and ChildHealth Bureau (MCHB) serves women and children through state programs, and the Bureau ofHealth Professionals serves to train a health workforce that is both diverse and motivated towork in underserved communities (HRSA 2003). An example of BPHC direct involvement inagricultural safety and health is through migrant health clinics. An example of MCHB directinvolvement in agricultural safety and health is through funding for the National Children’sCenter for Rural and Agricultural Health and Safety. BPHC also provides the majority of fundingfor both community health clinics and specific migrant health clinics. Funding for such clinicsrequires the collection of much categorical data on health services’ provision and use. However,most of this information is health related and not helpful in meeting occupational, particularlyagricultural occupational, data needs. And migrant health clinics in particular have little capacityto assist in research projects that do not include funding for the devoted time of staff toparticipate. EPA, NIEHS, NIOSH, and NIH should review their funding goals to ensure thatspecific occupational data not currently being collected is a target for study. In addition, theseagencies should include criteria for funding of the time of associated migrant clinic staffdedicated to assist with collecting the data.


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Strategy

B One of the EPA administrator’s charges is to ensure that the labeling and classification of pesticides protects farmers, farmworkers, and other persons coming in contact with the

pesticides or pesticide residues. Among the EPA’s attempts to meet this requirement are theWorker Protection Standard (WPS) and the Certification of Pesticide Applicators Standard (CAS),which were issued in 1992.

The WPS applies to all operators of farms, forests, nurseries, and greenhousesproducing agricultural plants (food, feed, and fiber plants, trees, turfgrass, flowers,shrubs, ornamentals, and seedlings); operators who hire or contract for services ofworkers; and anyone who applies pesticides to agricultural plants and crop advisors onany farm, forest, nursery, or greenhouse. WPS has no small farm exemptions orexemptions based on a minimum number of farm employees. The CAS requires anindividual applying restricted-use pesticides to be certified by a certifying agency ascompetent and thus authorized to use or supervise the use of restricted-use pesticides.(Runyan)

Regulations relating to these standards, such as provision of personal protective equipment,should be enforced as prescribed in the standards.

Strategy

C A major topic in individual presentations or discussions following (Duarte; Lighthall; Mandelbaum; Niedda) and within the work-group process were illustrations of perceived

barriers in the ability of workers to lodge complaints in the case of worksite violations. In somecases this amounted to the inability to access the reporting system in a timely manner or beingunable to answer specific questions during a report. An example of the former is being taken to afield by a labor contractor, being exposed to aerial pesticide spray, and having no access to aphone with which to report the incident. An example of the latter is being able to report such anincident but being asked questions related to the type of plane, the number on the plane, or theowner of the field—none of which the worker could respond to since (1) the worker’s head andface had been covered to limit the amount of exposure, and (2) the labor contractor actuallyemploying the worker had not provided information on whose field they were in.


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Strategy

D The specific evaluation strategies under this recommendation are intended to facilitate continued and additional involvement of farmworkers or their representatives in enforcement

of the current standards. While certainly not a comprehensive search, a review of Web-basedinformation on pesticide regulations and associated worker safety issues in California revealed noobvious specific mention of evaluation components. The California Department of PesticideRegulation Progress Report 2002 (CDPR 2003a) contains sections on “Protecting People” and“Enforcement in the Field.” The latter does identify enforcement targets resulting from recentfocus groups, including farmworkers, as “field posting . . . , notification requirements in general,and the hazard communication rules” (p. 15)—all needed, but employer directed. A review of theCalifornia Department of Pesticide Regulation Laws & Regulations site leads one to a link forFood and Agriculture Code, Divisions 6, 7, 13. A review of the entire posted code reveals nospecific mention of evaluation related to measuring code attainment in the 23 divisions listed.And a review of the California Code of Regulations (Title 3, Food and Agriculture) Division 6,Pesticides and Pest Control Operations (a citation in Runyan’s conference paper), again revealsno specific mention of evaluation or evaluation components. It is unquestionably possible thatworker safety and pesticide evaluation components are listed elsewhere on the CDPR site butwere not found during this exercise (CDPR 2003b).

Strategy

E Another topic of considerable discussion was the link between worker perceptions of individual or group power and health and safety needs (Lighthall; Mandelbaum; Neidda; work

groups). Workers’ lack of power at the worksite, as expressed in labor law, median income,short-term employment, language barriers, and dependence on employer housing and/ortransportation, to name only a few indicators, is compounded by other factors such asimmigration status and can have a profound negative impact on workers’ health. One majorimpediment to workers’ more directly addressing their concerns regarding workplace health andsafety is their lack of legal protection when filing complaints or expressing those concerns to theiremployers. In the case of H2A workers, this lack of legal protection is even more pronounced,often keeping workers from taking proactive stances to improve their worksites. Closely alignedwith the characteristics described is the quandary of being used for research without participatingwholly in the parameters of the investigation. Much funding has gone into studying how to formsuccessful partnerships for both programming and research. One of the major recommendationsto researchers is to seek partnerships with existing coalitions (Palermo). It is only logical thatthose being used to elicit the data should be involved in planning and carrying out the studies foreveryone’s benefit.


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R E C O M M E N D A T I O N 4Model agricultural safety and health programs related to health care services, professionaltraining, educating, and conducting applied research in community settings should be replicatedand evaluated to determine their effectiveness in other agricultural communities.


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Strategies

A USDA should target the development of information, assessment, and assistance programsthat address underserved populations in ways that are culturally sensitive to the differencesamong populations and base such programs on the successes learned with the NationalAgrAbility program.

B NIOSH should revitalize the Agricultural Health Promotion System (AHPS) funding stream.Such funding could focus on combining lessons learned from previous (AHPS) funding withnew findings from successful models of community-directed interventions.

C NIOSH should target specific funding within the Centers for Agricultural Disease and InjuryResearch, Education, and Prevention (Ag Research Centers) to form advisory committees offarmers and farmworkers to develop protocols for using community assets to collaborativelyconduct technical, anthropological, and social science research within the agriculturalcommunities.

Strategy

A Stories, peer and family pressure, awareness of and involvement in community-based activities, local and broad-based participation, and personal injury and illness experiences

have all been effective in providing the motivation and context for changing risky agriculturalsafety and health behaviors. Coalitions and partnerships, whether public or private, organizationor agency, individual or group, or combinations thereof, have provided the means to successfullyuse all these sources of motivation and more (Cole; Palermo; work groups). This report is repletewith examples of targets that need attention from research, programming, or both. This report

also includes many references to the failure to directly involve specific populations in theplanning of research directed at them or the planning of programs directed toward them.

Current funding requirements for research, programming, and program evaluation to include thetarget population in design, implementation, and evaluation represents an excellent start, andsuch efforts should be maintained and improved where possible. An example of a model forfunding such endeavors, which includes direct participation of the population, provides fundingopportunities for a partnership between federal and state agencies and not-for-profit disabilityorganizations, addresses clientele in a culturally sensitive fashion, and includes specific evaluationrequirements for continued funding, is the USDA/CSREES AgrAbility program (Field; Willkomm;work groups). Similar endeavors aimed at other underserved populations could elicit much datato fill the gaps currently outlined.

Strategy

B The NIOSH Agricultural Health Promotion System (AHPS) funding stream was previously available to state teams to accomplish specific agricultural safety and health objectives. Some

examples of funding targets within specific states are assessment of causative factors leading toinjuries (Missouri), development of model safety programs (Arizona), establishment ofcooperative relationships with a newly funded NIOSH Ag Center (Iowa), development of safetyand health instructional videos (Florida), and research to individualize the dose of pesticides fororchard trees (Washington), among many others (work groups; NIFS 2003b). Another benefit ofthese projects can be traced to seeds that matured after the three-year funded project. A goodexample occurred in Wisconsin, where funding from AHPS led to (1) improved networking andprogram collaboration among state agencies, (2) increased local programs for locally derivedconcerns, and (3) groundwork laid for state legislation. This Wisconsin legislation, Act 455,mandated and funded a tractor certification program for youth. This certification is necessary foryouth to legally operate tractors on public roadways (work groups; Skjolaas 2003). NIOSHshould review the long-term outcomes originating from AHPS funding with an eye for renewalduring its planning of future funding efforts.

Strategy

C NIOSH criteria for funding proposals for Ag Research Centers contain the following requirements related to community involvement in its four cores:

Administrative and Planning CoreAn External Advisory Committee, comprised of at least three members who are recognizedleaders in agricultural health and safety and regional agricultural experts, will provide overallguidance and advice to the principal investigator and program investigators on programdirection. If not already included in the Agricultural Center, one member should be from theAgriculture Extension community.


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Multidisciplinary Research Core(None)

Prevention/Intervention CoreMechanisms for establishing communication and active partnerships with local organizations,health care providers, educators, and community leaders;

Education and Outreach CoreProjects should involve regional agricultural stakeholders in addressing educational needs and inthe implementation of innovative approaches for meeting those needs. (NIOSH RFA: OH-03-002, 2003)

Specific language was added to include active participation of an advisory committee of farmersand farmworkers in using community assets to conduct joint, collaborative technical,anthropological, and social science research within the communities in their region. Directinvolvement, along with additional funds for such activity, will assist the Ag Research Centers inachieving overall goals as well as addressing current data gaps noted in this report (work groups).

R E C O M M E N D A T I O N 5Enhance collaborative efforts between professionals working in agricultural safety and health andprofessionals working in primary health care.

Strategies

A USDA should be allocated additional funds to designate a full-time national program leaderfor agricultural safety and health within the Cooperative State Research, Education, andExtension Service. Such a designation is not intended to supersede or replace currentlydelegated DOL, EPA, or OSHA oversight.

B In each state, USDA should fund a full-time state extension specialist in agricultural safetyand health with matching operating funds from the state. This position would collaboratewith the health specialist identified in strategy C below.

C In each state, NIOSH, HHS, or USDA should fund a full-time faculty position at acorresponding state university providing health professionals with matching operating fundsfrom the state. Utilizing the agromedicine model, this position would deal primarily withrural primary care and would work in collaboration with the state extension specialist inagricultural safety and health.

D USDA through the university-based extension system should facilitate collaboration ofprofessional organizations to provide for the continuing professional development ofagricultural safety and health professionals and primary care providers and other health careproviders on current issues related to the agricultural environment.


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Strategy

A A special work group involving designated representatives from the National Institute for Farm Safety (NIFS) and the North American Agromedicine Consortium (NAAC) was formed

to discuss and identify particular issues related to collaboration among agricultural safety andhealth professionals and primary health care professionals. NIFS is a leading organizationdedicated to reducing injury and illness incidence in agriculture. NIFS consists of agriculturalsafety and health professionals and interested organizations and seeks to provide a structure forthe development of those professionals. NAAC is devoted to the programmatic teamwork of landgrant and medical universities and their partners to promote health and prevent disease amongfarmers and farmworkers and their families, others in rural communities, and consumers of foodand fiber. Due to their experience in agricultural safety and health programming and research,and in collaborations merging safety, health, extension, and medical perspectives, representativesof these organizations were asked to summarize their consensus perspectives on agriculturalsafety and health issues for review by the other work groups and the project advisory committee.

The Cooperative State Research, Education, and Extension Service (CSREES) of USDA has beengiven the mission of advancing knowledge of agriculture, the environment, human health andwell being, and communities. One of the mechanisms for accomplishing this is partnership withuniversity-based cooperative extension systems within individual states. Most state cooperativeextension systems have a state specialist to assist state- and local-level extension personnel withspecifics related to agricultural safety and health data, research, and programming. One of theCSREES designated program areas is farm safety. However, at the current time there is no full-time designated leader for farm safety issues. In order for farm safety, and more broadly,agricultural safety and health issues, to receive the proper attention and to facilitate the otherstrategies under this recommendation, a full-time program leader is needed.


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Strategy

B An additional objective is to reestablish full-time state-level agricultural safety and health specialist positions in states where they are needed but in which such positions have been lost,

or in which a specialist position is shared with another state. University-based extension systemsoperate on a formula basis, with resources from federal, state, and local entities. It is apparentthat having safety and health specialists available when needed would be beneficial, given theincreasing median age of farm operators and the associated increase in age-related afflictions;research indicating the potential hazards of exposure to pesticides and of naturally derivedorganic and inorganic compounds; environmental and ergonomic factors; the lack of availablerural health care; the growing populations of women and the disabled; increasing numbers ofmigrant and seasonal laborers lacking prior health care access; and specific health hazardsassociated with production practices in different areas of the country (Chapman; Field;Hernandez-Peck; Kirkhorn; McCoy; Niedda; Willkomm; work groups).

Strategy

C The abovementioned factors also make a case for funding a primary health care specialist to work in conjunction with the agricultural safety and health specialist. It is impossible for a

single person to have the time, much less the necessary knowledge, to deal with all the issuessurrounding agricultural safety and the health-related components now identified withinagriculture. A health specialist with experience in primary health care and some knowledge ofagricultural issues would be of great benefit to a specialist experienced in agriculture with someknowledge of health care issues. Funding for such positions would supplement designatedfunding through specific HHS or NIOSH programs. Since CSREES is already located in USDA,another alternative would be to have the additional funding come through USDA and CSREES asa designated program, as farm safety is now.

Strategy

D Until the implementation of the preceding strategies to help formalize the many contacts and collaborative activities already occurring, USDA through CSREES should continue to

facilitate interaction among concerned professionals and their organizations. Agricultural safetyand health professional involvement with national and state rural health associations; continuingmedical education courses; advanced-degree committees in community health, nursing science,agricultural education, and other disciplines; and oversight of internships and traineeships allcontribute to individual participant awareness as well as interdisciplinary interaction onagricultural safety and health issues.

Medical and health professionals likewise can increase their understanding of and professionalpractice in agricultural safety and health through agriculture-specific programs. Courses such asthe Agricultural Occupational Health Training Program at the University of Iowa provide basicinformation and skills that enable the health care professional to function as a practitioner in theprevention of occupational illnesses and injuries in the farm community (ICASH 2003). Medicaleducation for agricultural health and safety that involves aspects of primary care, rural


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community health care, and occupational and environmental medicine is available atagromedicine programs, such as the one at the University of Alabama (Wheat) or throughNIOSH-funded Education and Research Centers with agricultural safety and health academic andtraining programs (work groups).

R E C O M M E N D A T I O N 6Increase the capacity to provide rural emergency medical services, agricultural occupationalhealth services, mental health care, rehabilitation services, and education to the agriculturalcommunity.

Federal Strategies

A An interagency agreement between Department of Transportation/National Highway TrafficSafety Administration, Department of Homeland Security, Department of Health andHuman Services, and United States Department of Agriculture should be developed to


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designate a single site with specific authority for administration and funding to ensure thatrural emergency services remain an integral part of national emergency service capabilities.

B The Rural Emergency Medical Service Training and Equipment Assistance Program,authorized in the Health Care Safety Net Amendments of 2001 (P.L. 107-251), shouldreceive funding appropriations as designated through the U.S. Department of Health andHuman Services and administered by the Health Services Resources Administration.

C The National Institute of Mental Health/Office of Rural Mental Health Research and theNational Advisory Committee on Rural Health and Human Services/Office of Rural HealthPolicy/Health Resources and Services Administration should work collaboratively indeveloping a National Center for Agricultural Behavioral Health to facilitate the interface ofresearch and service delivery relating to addictions, mental health, and social psychologicaldistress found in the agricultural setting.

D Target musculoskeletal disorders for CDC/NIOSH funding and support for expanded fieldintervention and prevention in cooperative partnerships with farmers and farmworkers.

State Strategy

E State university–based Cooperative Extension offices should establish formal relationshipswith state Public Health Departments and state Environmental Protection Agency offices tofacilitate the formation of a task force to provide pesticide prevention programs for farmers,migrant/seasonal farmworkers, and their families, as well as rural residents.

Local Strategy

F Recruitment and retention of rural emergency volunteers should be the topic of in-depthresearch at the community/squad level in order to understand the problem. Subsequentplanning and action should be based on the findings of that research.

Strategy

A The National Highway Traffic Safety Administration (NHTSA), under the U.S. Department of Transportation, was established by the Highway Safety Act of 1970, as the successor to


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the National Highway Safety Bureau, to carry out safety programs under the National Trafficand Motor Vehicle Safety Act of 1966 and the Highway Safety Act of 1966 (HSA). Under theHSA revision of 1998, NHSTA continues to specify the curricula for emergency medical servicethat must be met by the states for certification of health care providers. Although it is true thatNHTSA does not have direct control at the state level (it is up to the states to determine howthings get done), it can and does influence state-level decisions (NHTSA 2003b; Erisman a; workgroups).

The recently established Department of Homeland Security (DHS) has component agenciesdirected to protect our critical infrastructure and coordinate the response of our nation to futureemergencies. It also makes funding available to state and local public safety and law enforcementpersonnel to help prevent, prepare for, and respond to terrorism. The passage of the PublicHealth Security Bioterrorism Preparedness and Response Act of 2002 (2002 Act) has componentsthat are being addressed in a joint fashion by HHS, through CDC, and USDA, through itsAnimal and Plant Health Inspection Service (APHIS). The 2002 Act contains specifics relatedboth directly and tangentially to agricultural and rural care provision in Section 131, “Grants toImprove State, Local, and Hospital Preparedness for and Response to Bioterrorism and OtherPublic Health Emergencies.” The extension of these agreements to allow for a single designatedsite with specific authority for administration and funding could ensure that rural emergencyservices remain an integral part of national emergency service capabilities, along with agriculturaland rural population protection (USDHS 2003; USDA APHIS 2003; Erisman b).

Strategy

B The Rural Emergency Medical Service Training and Equipment Assistance Program was authorized in the Health Care Safety Net Amendments of 2001 (P.L. 107-251) in October

2002. The program has been authorized to provide such sums as are necessary for fiscal years


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2002 through 2006, and there is a 25% non-federal matching requirement. This program has anindefinite authorization (no limit), but has never received any appropriation.

The funds can be used to:

• Recruit emergency and volunteer medical service personnel

• Train emergency medical service personnel in emergency response, injury prevention, safetyawareness, and other topics relevant to the delivery of emergency medical services

• Fund specific training to meet federal or state certification requirements

• Develop new ways to educate emergency health care providers through the use of technology-enhanced educational methods (such as distance learning)

• Acquire emergency medical services equipment, including cardiac defibrillators

• Acquire personal protective equipment for emergency medical services personnel

• Educate the public concerning cardiopulmonary resuscitation, first aid, injury prevention,safety awareness, illness prevention, and other emergency preparedness topics

The appropriation of funds through the public law as designated would begin the process ofaddressing several of the concerns related to the training and equipping of volunteers to meetsome of the emergency medical services needs found in rural America (Erisman 2003; workgroups).

Strategy

C Three current activities within the Department of Health and Human Services offer an opportunity for intergovernmental collaboration to address the current lack of mental health

resources in agricultural and rural areas. The National Advisory Committee on Rural Health andHuman Services (NACRHHS)/Office of Rural Health Policy/Health Resources and ServicesAdministration is now progressing on its work plan for 2003 and 2004. This plan includes anexamination of the integration of behavioral health and primary care in rural settings and accessto oral health care services in rural communities. The committee will also focus on issuesaffecting the rural elderly (NACRHHS 2003).

In addition to this effort, the National Institute of Mental Health/Office of Rural Mental HealthResearch is charged with the following duties: (1) direct, plan, coordinate, and support researchactivities and information dissemination on conditions unique to those living in rural areas,including research on the delivery of mental health services in such areas; and (2) coordinaterelated departmental research activities and related activities of public and nonprofit entities.Also, NIOSH, within the National Occupational Research Agenda (NORA), lists as priorityresearch areas Special Populations at Risk and Health Services Research. However, neitherNORA priority area specifically mentions mental health. A National Center for AgriculturalBehavioral Health, developed from among the current various offerings, could facilitate theinterface of research and service delivery related to addictions, mental health, and socialpsychological distress found in the agricultural setting (Rosmann; work groups).


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Strategy

D Organized surveillance of musculoskeletal disorders in agriculture is virtually nonexistent. And, as with other data outlined, the annual Bureau of Labor statistics are inadequate for

determining the extent and severity of musculoskeletal disorders and other work-related healthproblems within production agriculture. Specific studies such as those of agricultural workers inCalifornia report rates of musculoskeletal disorder ranking among the highest in all industries,and many times greater than the rates suggested as industrial targets. Recent research bymultidisciplinary teams of researchers and extension staff have organized intervention andprevention programs based on an ergonomics approach to the problems involving specific toolsand tasks encountered in agricultural workplaces. These programs have been largely successful indeveloping low-cost intervention strategies, which have proven acceptable to farmers andfarmworkers, and have proven effective at significantly reducing specific risk exposures. NIOSHhas published Simple Solutions, which highlights many of these agricultural successes and canserve as a guide in structuring further research and programming (Chapman). NIOSH shouldcontinue to offer interdisciplinary research grants and cooperative agreements targetingergonomic issues in agriculture through National Occupational Research Agenda priority areassuch as musculoskeletal disorders and control technologies and personal protective equipment(NORA 2003).

Strategy

E The Cooperative State Research, Education, and Extension Service (CSREES) of USDA has been given the mission “to advance knowledge for agriculture, the environment, human health

and well-being, and communities” (USDA CSREES 2003). One of the mechanisms foraccomplishing this mission is to partner with university-based cooperative extension systemswithin individual states. Most state environmental protection agencies follow the EPA’s generalmission to protect human health and to safeguard the natural environment—air, water, andland—upon which life depends (USEPA 2003). In addition, the EPA is given primary nationalresponsibility for maintaining standards related to pesticides and their application (Runyan). Thegeneralized goal of state public health departments is to promote the health of the people throughthe prevention and control of disease and injury.

As can be seen, there is overlap in the general aims of individual agencies. In many instancesthere are both formal and informal contacts on many subjects between the state-level agenciesalready. The recommendation is that state Cooperative Extension offices take the lead in bringingforth the issue of specific programs, either new or reinforced, on potential exposures to pesticidesin the residences of farmers, migrant/seasonal farmworkers, and their families, as well as ruralresidents, in addition to specifics related to pesticides exposure at worksites. Having formalrelationships on the issue at the state level will facilitate offering coordinated programs within thelocal offices affiliated with each individual agency.

Strategy

F The most important issue in rural emergency care is the declining number of emergency caregivers to service rural America. Recruitment and retention are the critical issues that must


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be addressed. If caregivers are not available in rural areas, other issues are moot. The evidenceshows that:

1. The overwhelming majority of rural America is serviced by unpaid volunteers.

2. Low call volume makes private EMS care providers financially infeasible.

3. Volunteer EMS caregivers are not dollar motivated. As repeatedly established in theliterature, the volunteers do not do the job for pay. They have other motives thatdrive them. (Erisman 2003)

No one suggests that it is feasible to have enough dollars to replace the unpaid volunteer ruralcaregivers with paid personnel. An example helps establish perspective:

A township ambulance provides emergency medical services for the township residentsand mutual aid to surrounding townships. Last year the cost for personnel (gas moneyto respond to emergencies, training, clothing) and miscellaneous support equipment(not counting the depreciation on the ambulance) was $15,000. For those dollars allresidents and persons traveling through the area received 24-hours-a-day, seven-days-a-week, for 52 weeks, coverage for any medical emergency that might arise. To replacethat service with paid personnel would require a minimum $250,000. Paid personnelcoverage is simply not a viable economic option. (Erisman 2003; work groups)

Given the low potential for paid personnel coverage, further in-depth research into recruitmentand retention will be needed in order to determine how to best address the problem.

The superficial data available is not useful in providing guidance about substantive, effectiveideas for resolution. Research must be done at the community/squad/grassroots level tounderstand the population’s perceptions of their problems and ideas for assistance. They hold theanswers to questions about what needs to be done. Planning and actions should be based oninformation provided by the community and the rural squads. Until we get the data needed, weare simply speculating about steps that need to be taken to reverse the trends (Erisman 2003;work groups).


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R E C O M M E N D A T I O N 7Enhance determinant research that examines how various risks and protective factors affect thehealth of the agricultural community.


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Strategies

A NIOSH, NIEHS, and EPA should continue funding investigations related to improvedassessments of indoor air exposure for confinement workers and better defineRecommended Exposure Limits (RELs, NIOSH) and associated Permissible Exposure Limits(PELs, OSHA) to reflect any dose-response relationship found.

B The EPA should target additional technical, epidemiological, and exposure assessments todefine the emission elements responsible for specific community effects found with largeconfinement animal production.

C BLS and NIOSH should collaborate to allocate funding, similar to NIOSH Sentinel EventNotification System for Occupational Risks (SENSOR) projects, toward protocols toimprove the delivery of standard medical surveillance to agricultural workers, includingimproved reporting and tracking of occupational injury and illness.

D NIOSH and privately and publicly owned corporations should increase efforts toward thestandardization and improvement of biomarker assessments relating to agricultural illnessand disease.

E EPA and privately and publicly owned corporations should target funding for research toestablish causal linkages or dose-response relationships between chronic illness and pesticideexposure; critically important is research into potential endocrine disruptor effects ofpesticides.

F The National Cancer Institute should target funding for long-term research on the possibleassociation of nitrate in drinking water with cancer risks that addresses the inherentweaknesses of currently available case-control and ecological studies.


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Strategy

A NIOSH develops and periodically revises recommended exposure limits (RELs) for hazardous substances or conditions in the workplace. As identified, these are recommended limits, as

NIOSH is a research agency, not an enforcement agency. These recommendations are taken intoconsideration to set the Permissible Exposure Limits (PELs) used by OSHA. A PEL is the amountor concentration of a substance in the air that is permitted by OSHA, an enforcement agency.OSHA uses the PEL to gauge employer compliance or noncompliance with applicableregulations. While much research has been done on and in confined animal feeding operations(CAFOs), much more work needs to be done to properly identify hazardous substances in theseenvironments. This research will aid in verifying the concentrations of these substances thatprompt a response from workers and endanger their health (Kirkhorn; Thu; Von Essen; workgroups). The respective agencies that are currently involved in the multistep process of decidingRELs and PELs should continue their efforts in this area.

Strategy

B An associated concern with setting appropriate RELs and PELs in CAFOs beyond workers’ health needs is the issue of emissions from such operations and the potential impacts on those

living around them. Anyone who has passed a large hog production CAFO on a hot, humid daywill attest to there being a detectable odor and perhaps even a pervasive atmosphere associatedwith it. Whether this odor and atmosphere is determined to be pleasant or unpleasant, fragranceor stench, is strictly a personal matter. The perceived harm that might arise from this odor oratmosphere is of importance and would be classified as pollution. As the EPA has primaryresponsibility in the area of pollution, it should subject this situation to the additional researchthat is needed.


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Strategy

C The NIOSH Sentinel Event Notification System for Occupational Risks (SENSOR) has as its mission to provide leadership to prevent work-related illness, injury, and death by gathering

information, conducting scientific research, and translating the knowledge gained into productsand services (NIOSH 2003d). SENSOR Surveillance Goal 3 is to “strengthen surveillance of high-risk industries and occupations, and of high-risk populations, including special populations.”Under Goal 3 is Objective 3.1, to “enhance surveillance of occupational illness, injuries, andhazards in agriculture,” and Objective 3.5, to “assess the needs and explore the opportunities foradditional surveillance in other occupations and demographic groups that are at high risk ofoccupational illness and injuries, such as special populations.” The implementation of projects toaddress these objectives should be undertaken with BLS and NIOSH working jointly to establisha mechanism to fill current gaps in data in a manner that would be useful to both agencies.

Strategy

D Biomarkers can be defined as indicators that signal events occurring in biological systems or samples. Molecular biomarkers are the kind used in environmental health, research, and

medicine. The three broad categories of molecular biomarkers commonly used are biomarkers ofexposure, biomarkers of effect, and biomarkers of susceptibility. Regardless of the category, muchbasic research is required before the specific use of these biomarkers within occupational settingssuch as agriculture is possible. NIOSH, having primary federal responsibility for agriculturaloccupational research, and privately and publicly owned corporations, both benefiting from andcontributing to federally funded programs, should continue to concentrate their efforts in theprofitable use of biomarkers to protect the health and safety of farmers, farmworkers, theirfamilies, and all rural residents (Kirkhorn; Fuortes; Weyer; Wilson & Suk 2002; work groups).

Strategy

E The use of molecular biomarkers, and the many other measures necessary in identifying human health hazards, is directly related to research to establish causal linkages or dose-

response relationships between chronic illness and pesticide exposure. Causal linkages aredetermined by principles that lead to a judgment of whether the available information is ofsufficient quantity and quality to establish a sound connection. A dose-response relationship isanother way of determining cause; the greater the amount of exposure to a risk factor, the greaterthe chance of a harmful effect (Woodward 1999). As with most human endeavors, there can beinformed opinions that reach different conclusions, and there is much disagreement on whether aspecific set of evidence indeed fulfills the requirements for establishing a causal linkage or dose-response relationship (Kirkhorn; Fuortes; Niedda; Von Essen; Weyer; work groups).

This statement applies broadly to the potential relationship between illness and pesticideexposures, and specifically to the area of endocrine disruptors. The endocrine system in humansregulates and integrates the functions of different cells through glands that produce hormones.The endocrine system is responsible for metabolism, growth, maintenance, automatic bodilyresponses to environmental changes, and reproduction. The term endocrine disruptor refers toany substance from outside the body that has a negative effect on the endocrine system,particular the reproductive organs. There are several classifications of endocrine disruptors


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(Birkett & Lester 2003). The EPA and private and public corporations should continue theresearch focus on this important topic.

Strategy

F The National Cancer Institute (NCI)/National Institutes of Health “coordinates the National Cancer Program, which conducts and supports research, training, health information

dissemination, and other programs with respect to the cause, diagnosis, prevention, andtreatment of cancer, rehabilitation from cancer, and the continuing care of cancer patients and thefamilies of cancer patients.” A search of the NCI site for research using first “nitrates” and then“pesticides” as the key words found two studies listed for nitrates and 29 listed for pesticides(NCI 2003a, 2003b). Some of these studies involved basic surveillance to assess exposures, andmany others were designed using case-control or ecologic studies.

Case-control studies identify a set of individuals with a disease and a set of people without thedisease. The two sets are then compared with regard to a risk factor. Such studies can includemany risk factors but can study only one disease. They cannot be used to measure the chance ofa disease occurring in another person. But these studies are attractive for diseases that take a longtime to develop (Woodward 1999). Ecologic studies assume that relationships found in allexposures will apply to any individual. This is an inherent weakness, and much of the previousnitrate data relied on deaths from cancer and used residence at the time of death as the locationfor the entire lifespan. Associated common weaknesses are failure to account for any delay thatoccurs before the disease presents itself and failure to account for other possible risk factors forthe disease (Weyer). It is essential that long-term research using more robust study methodologybe conducted.


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R E C O M M E N D A T I O N 8Apply to the fullest extent current advances in engineering and application technology to reducefatalities, injuries, illness, and disease in the agricultural community.

Strategies

A Continue dissemination and evaluation of the recommendations to reduce tractor-relatedinjuries and deaths produced at the Tractor Risk Abatement and Control policy conference(Donham et al. 1997), particularly with those audiences whose collaboration will be neededto enact said recommendations.

B USDA, through the Cooperative State Research, Education, and Extension Service (CSREES)and the university-based extension system, should take the lead in facilitating the application of industry-wide, low-cost ergonomic interventions and commodity-specific standardizationof improved ergonomic tools, using successes such as those in the NIOSH publicationSimple Solutions: Ergonomics for Farm Workers as a model.

C American Society of Agricultural Engineers and Society of Automotive Engineers, throughvoluntary standards, should facilitate the use of universal design concepts to foster thedevelopment of high-quality and task-specific materials for use in safety and healthequipment for the disabled.


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Strategy

A The University of Iowa convened a policy conference in 1997 in recognition that little had been accomplished in reducing agricultural fatalities related to the tractor. The Tractor Risk

Abatement and Control (TRAC) conference published a report with 25 specific items that, ifimplemented, would save an estimated 2000 lives by 2015 (Donham et al. 1997; Myers).Recommendations carried various dates of implementation and included developing educationaland social marketing programs to change social norms regarding rollover protective structures(ROPSs); requiring that all tractors sold be equipped with ROPSs; requiring that all tractors beequipped with approved ROPSs; utilizing incentive program to ensure operator knowledge ofsafe tractor operation; prohibiting the driving of tractors on roads by persons without a validdriver’s license; and developing social marketing programs to discourage extra riders; andrequiring youths to have formal tractor operator training.

Several of the TRAC recommendations have been addressed in part. Equipment manufacturershave provided incentives to retrofit ROPSs on older tractors. Insurance incentives are beingstudied in conjunction with agricultural safety and health training and health provision, as in theCertified Safe Farm program. The state of Wisconsin has legislation, Act 455, mandatingcertification of training for youth to legally drive tractors on public roadways. Agencies andorganizations such as NIOSH, the National Children’s Center for Rural and Agricultural Safetyand Health, National Institute for Farm Safety, National Safety Council, Progressive FarmerFoundation, and Farm Safety 4 Just Kids have all used marketing and offered specific programsto discourage the practice of extra riders on tractors. However, there remains much to be doneon specific TRAC recommendations. In addition, many audiences remain to be involved in orderto fully reach TRAC objectives. We encourage the dissemination and evaluation of the TRACdocument.

Strategy

B A review by the University of California Agricultural Ergonomics Research Center over the past decade cited three general risk factors as both endemic and of highest priority throughout

the agricultural industry. They are lifting and carrying heavy loads (over 50 pounds), sustained orrepeated full-body bending (stoop), and highly repetitive hand work (e.g., clipping, cutting). Eachtype of production agriculture has its own unique ergonomic hazards and musculoskeletal injuryproblems, although some hazards are similar throughout production agriculture in general. Itshould be noted that while many of the types of hazards reported can be said to be of generalindustrial concern, most interventions, even those patterned on proven strategies and engineeringcontrol concepts, must be individually evaluated. As a result, there are simply now no ready, off-the-shelf tools and technologies for addressing most of the ergonomic hazards found inagricultural workplaces (Chapman).

As an example, well-designed interventions have successfully persuaded some farm managers offresh market vegetable operations in Minnesota, Wisconsin, Illinois, and Iowa to adoptproduction practices and labor aids that reduce exposures to musculoskeletal injury hazards. Thecrucial factor was having a group of research scientists coupled with outreach specialists, pilotfarmers, and agricultural specialists all funded to work toward the same purpose: identification,control, and industry-wide prevention (and intervention evaluation) of musculoskeletal disordersin specific agricultural commodity areas. In addition, focusing on the promotion of production


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methods and labor aids that were not only safer but also sustained or improved productionefficiencies ensured their popularity with farm managers. CSREES has an established network ofuniversity-based extension personnel with expertise in translating research into practice. CSREES,with additional targeted funding, could model proposal-based funding similar to its AgrAbilityprogram toward ergonomics and musculoskeletal injuries in production agriculture (Chapman;work groups).

Strategy

C Universal design (UD) is an approach to designing all products and environments to be used by as many people as possible regardless of age, ability, or situation. Examples of

considerations related to UD include sight, hearing, movement, and thought processes. Specificapplications of UD can range from choice of text font, font size, and placement on Web sites orin presentations, to lever-type rather than round handles for doorknobs, to design considerationsfor interior spaces such as the width of hallways and doorways, to height of light switchplacement, to kitchen equipment and cabinet design options. A water cooler may need to be adual-height model, with both standard and lower spouts and controls. To create a universallyusable group toilet room, two types of accessible toilet stalls may need to be installed. Auniversally usable landscape design may include alternative paths free of steps and stairs. Thewidespread use in product design of universally usable features such as touch-sensitive controls isbringing the UD approach into the market for consumer items (Universal Design EducationOnline 2003; Field; work groups).

In some cases, there is a need to develop new standards or expand existing designstandards to provide clear direction to professionals designing and fabricating assistivedevices and making modifications to existing equipment such as tractors and combines.Some of these standards would be channeled through existing voluntary standardsorganizations such as ASAE or SAE that have jurisdiction over much of the technologyassociated with agricultural workplaces. Design strategies that have become a commonpart of the “Universal Design” approach should be considered and incorporated intonew agricultural production facilities and older facilities as they are remodeled. Thesedesign concepts have become widely used to successfully enhance the accessibility andusability of a wide range of facilities and products. (Field; work groups)


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R E C O M M E N D A T I O N 9Investigate the safety and health impacts of the annual exemptions from federal agencyenforcement of regulations provided to agriculture.


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Strategies

A Form a task force composed of individuals representing farm organizations, farm employerorganizations, farmers, farmworkers, appropriate researchers in pertinent fields, agriculturalhealth care providers, and applicable governmental agencies to evaluate the overall impactof two important exemptions now applied to agriculture. NIOSH funds channeled throughthe Ag Research Centers would cover the travel and lodging of task force representatives.The two exemptions to be evaluated include:

1. “U.S. Department of Labor should exclude from OSHA protection all agriculturalworkers in agricultural operations employing 10 or fewer non-family workerswithin the past 12 months, and having no temporary labor camps in the last 12months. The U.S. Department of Labor has interpreted this to mean that whenevera farm operation has more than 10 workers employed on any 1 day, the operationis subject to OSHA regulation” (Runyan).

2. “Permit Required Confined Spaces (PRCS) and under OSHA’s guidelines, can onlybe entered by developing and following a plan addressing the hazards found in thatspace. The characteristics of a PRCS, are found under OSHA’s Confined SpaceStandard (29 CFR 1910.146) but family farms are exempted from the PRCSstandard” (Steffen).

Strategy

A As documented in this initiative, there has been much progress made in agricultural safety and health since the publication of Agriculture at Risk: A Report to the Nation (Merchant et

al. 1989). The advances and successes that have been made in areas ranging from childhood andyouth safety and health; to community coalitions; to improved understanding of the uniquemental health issues of farmers; to ergonomics; to injury, illness, and disease prevention andtreatment; to techniques shown to enhance safety and health behaviors; and the stories thatunderlie them must continue to be disseminated as reminders to previous audiences and to newaudiences as they become available, aware, and interested.

As has also been documented, much remains to be done. The advances taking place inproduction agriculture cannot be overemphasized, and current gaps and needs in data, research,and programming are plentiful. The increasing age of farmers, the decreasing number of youngerpeople entering farming, the growing size of farms and equipment, the increasing numbers ofwomen and disabled involved actively in farming, and the growing number of farmworkers fromdifferent cultures without English as their primary language all require attention.

The relative stability in the rates of agricultural injuries and fatalities compared with otherindustries, the lack of health care availability and access in rural areas, the prominence of mentalhealth disorders in agriculture and rural populations, the continuing decline of rural emergencypersonnel, most of whom are volunteers, all require specific efforts for remediation.

There is a marked lack of good data to use as a guide to target programming and to use asbaselines in evaluating our efforts. We do not know enough about specific causes of exposure tocommon agricultural inputs such as nitrates and pesticides; about respiratory illnesses related toconfinement animal feeding operations or dry land farming; about specific health differencesbased on racial, ethnic, or cultural characteristics; or about how to meet the needs of thosepopulations to address those health and safety hazards that we do have solid information on.

However, in all of these areas, specific questions regarding the overall and direct impact of thetwo important exemptions cited above are not asked. This is partly due to the nature of research,with its detailed objectives and explicit means. This is also partly due to the coordination thatwould be needed to cover the many disciplines, agencies, and organizations and the large scaleinvolved.

Truly understanding if and how these exemptions impact the health and safety of farmers,farmworkers, and their families is fraught with difficulties and complexities. Such an effort wouldnecessarily be long term but could provide direction for future funding. The specificrecommendations in this report and the several strategies suggested for achieving thoserecommendations collectively might provide a starting point for investigating possible impacts.And the broad expertise needed to implement the strategies with the direct involvement of localindividuals and organizations would provide a nice pool from which to select representatives.Since the NIOSH Ag Research Centers already have regional, state, and local contacts andspecific criteria for advisory committees, the task force suggested seems a natural extension.

Some will view the very idea of this recommendation as contentious, arbitrary, and unnecessary.Others will claim that this recommendation does not go nearly far enough and that theexemptions should be removed regardless. Each view has its salient points and each has evidenceto justify its position. I simply ask for the suggestion to be pondered and the advantages of beingable to truly identify the direct impacts from these exemptions to be weighed.


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Public Health Perspectives Editor’s Note: ASH-NET sought the review of and advisement on this document by a publichealth professional with experience working within the agricultural community. Natalie Roy,MPH, Business and Development Director of the AgriSafe Network, graciously agreed to providethis needed perspective on the document contents along with specific suggestions related to theinterface of public health and agricultural issues at the federal, state, and local levels.

Document ApplicabilityThe Institute of Medicine’s Future of Public Health report has summarized public health practiceas involving three core functions (IOM 1988):

• Assessment—of a community’s health and its resources

• Policy development—to promote health and solve health problems

• Assurance—that access to health care, promotion, and prevention services are available

The recommendations outlined in this document include all three core components and theessential public health services that are included in the core components. Adapted from the TenEssential Public Health Services of the U.S. Department of Health and Human Services(USDHHS 1995), these 10 services are depicted throughout this document and reflect the uniquehealth and safety needs of the agricultural community:

• Monitoring health status to identify health problems of the agricultural community

• Diagnosing and investigating health problems and health hazards in the agriculturalcommunity

• Informing, educating, and empowering farmers about health and safety issues

• Mobilizing community partnerships to identify and solve agricultural health and safetyproblems

• Developing policies and plans that support individual and community health efforts

• Linking farmers to needed personal health and safety services and ensure the provision ofhealth care when otherwise unavailable

• Enforcing laws and regulations that protect health and ensure safety

• Assuring a competent public health and personal health workforce with training in the field ofagricultural health and safety

• Evaluating effectiveness, accessibility, and quality of personal and population-based health andsafety services for the agricultural community

• Researching for new insights and innovative solutions to health and safety problems


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The most effective prevention works at multiple levels—federal, state, and local—simultaneously.Although this document focuses primarily on federal initiatives, success is dependent on theactions of different agencies, researchers, educators, health professionals, and policymakers, eachof which is integral to achieving the goal of a healthier and safer agricultural community.

The National Institute for Occupational Safety and Health (NIOSH) and other CDC centers,such as the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP),are focusing on the integration of research findings into public health practice. This document,which was developed by researchers, practitioners, and farmers, outlines recommendations thatrequire an interdependence between those working in the field of research and those providingservices. The research priorities listed in this document are based on program needs and directionfrom the agricultural community. In turn, the service and training priorities listed in thisdocument are based on research findings conducted in the past.


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Policy/Program

Research Questions

Research Translation

Research Methods

Research Findings

Figure 1 (taken from the research agenda of NCCDPHP) illustrates the positive feedback loop oftranslating research into practice.

Public Health Interfacing with AgricultureCenters for Disease Control and Prevention

1. The Public Health Practice Program Office (PHPPO) within CDC should integrateagricultural health and safety distance learning in the course offerings supportedthrough the Public Health Training Network (a program of PHPPO). PHPPO providesdistance learning courses on a variety of topics with the intention of strengthening thepublic health workforce. Inclusion of agricultural health and safety distance learningcourses would reach a broad audience of public health practitioners. Academicinstitutions that are leaders in the field of agricultural health and safety couldcollaborate with PHPPO to develop distance learning courses.

2. The National Center for Chronic Disease Prevention and Health Promotion(NCCDPHP), a center of CDC, should develop and test Behavioral Risk Factor Survey(BRFS) modules that measure the health and safety needs of the agriculturalcommunity. Pretested standard core questions would enable health professionals tomake comparisons between states to establish national agricultural health and safetypriorities.

State Public Health Professionals and Policymakers

State public health professionals and policymakers working in state offices can have a significantimpact in improving the health and safety of the agricultural community. Examples of stateagencies that have focused efforts on the farming population include, but are not limited to,Departments of Public Health, Insurance Commissions, Transportation Departments,Departments of Education, and Departments of Agriculture.

1. Include questions about occupation type and farm-related illnesses and injuries in theBehavioral Risk Factor Survey (BRFS). The Behavioral Risk Factor Surveillance System(BRFSS) is a telephone survey conducted by all state health departments, the District ofColumbia, Puerto Rico, the Virgin Islands, and Guam with assistance from CDC. Statesuse BRFSS data to track critical health problems and to develop and evaluate publichealth programs. The system is flexible and allows for the addition of questions tomeet the needs of each state. States should consider developing and including questionsthat specifically relate to the health and safety issues of the agricultural community.New Hampshire, for example, used BRFSS data to highlight differences between ruraland urban health risk behaviors. The report was then used to justify the need for aState Bureau of Rural Health. The same approach could be taken to examinedifferences in agricultural and nonagricultural risk behaviors.

2. State-based insurance reform often centers on decreasing the number of citizens whoare uninsured. The majority of farmers, however, are considered underinsured,indicating limited coverage and limited access to preventive services. Health insuranceplays a critical role in ensuring that people obtain timely medical care that isappropriate. In an era of high health care costs, individuals’ difficulty in affordingmedical care has made health insurance essential for ensuring that health services areboth accessible and affordable. In a 2001 study conducted with farmers in NorthwestIowa, both men and woman with coverage from a self-purchased plan were less likelyto receive important preventive services than those farmers covered by an employee-sponsored plan. Particular attention was given to differences found among


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employee-sponsored versus self-purchased plans. The importance of this distinction isto highlight the significance of evaluating the type of coverage and not merely whethersomeone has coverage. Too often policies or pilot programs focus on decreasing thenumber of uninsured, with very little emphasis on the quality of health coverage. Afarmer with an insurance policy that covers only major medical costs is most likely notreceiving adequate care compared with those with full coverage.

Health Care Providers and Community Educators

1. When county need assessments or other types of surveys are conducted in rural areas,occupation type should be captured in order to examine the unique health and safety needsof the farming population. Initiatives intended to improve rural health often do not addressthe unique health needs of farmers, seasonal farmworkers, and migrant workers. Collectingdata by occupation can define differences in access to care, utilization of care, and healthstatus among the agricultural an non-agricultural community.

2. To ensure that farmers are not lost in the health care system, local service agencies need todevelop strategies to coordinate, enhance, and expand access to health care. In addition todeveloping an extensive referral system with health care providers, other entities such asextension services, schools, agribusinesses, commodity groups, religious organizations, andhealth and human service agencies can assist in the promotion of agricultural health andsafety issues. Public awareness programs can be held in conjunction with communityactivities such as pesticide applicator training sessions and local vocational agriculturalclasses at community colleges and high schools.

3. All health professionals working in locations where agriculture is prevalent should receivecontinuing education in the field of agricultural health and safety. Farmers are much more aptto value services offered by providers who understand their unique occupational healthproblems and the nature of their work life on the farm. Valued services, in turn, lead to betterunderstanding of preventive care and adoption of safe work practices. Therefore, the moreprofessionals can learn about the farm work environment, the better equipped they will be inproviding services. For example, the Center for Agricultural Safety and Health at the Universityof Iowa provides intensive continuing education in the field of agricultural health and safety.

4. Health care providers should take an active role in improving the quality and reducing thecost of health insurance coverage for farm families. Various health and social serviceorganizations strive to provide care to the farming population without understanding thefinancial obstacles that can reduce utilization of much-needed care. Local health providersshould examine the health insurance problems unique to their community, especially if theseproblems reduce access to care. In a 2001 study in northwest Iowa, farmers in the lowestincome bracket were the most likely to lack health coverage. Interestingly, it is these farmerswho would be eligible for either Medicaid or the Children’s Insurance program. Healthproviders can take an active role in promoting the use of government funded programs forthose farm families who are eligible.

5. Health professionals should collaborate with community colleges and universities to accessresources, model programs, and technical assistance related to agricultural health and safety.Health professionals who develop partnerships with academic institutions can obtainimportant resources to enhance the care they provide to the agricultural community. Forexample, occupational health histories initially used for research purposes may be beneficialto the clinician in directing patient care.


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6. Include cause of injury (farm related, non–farm related) and occupation when enteringadmission data at the emergency room. Important data on the prevalence of agricultural-related injuries is often lost because the appropriate information is not gathered during theemergency room visit. If adequately captured, such information can help health and safetyspecialists focus efforts and resources on the areas of greatest need.

7. Engage farmers and farm workers in identifying and improving the health and safety needsof the community. Too often health care professionals determine the needs of a communityor an individual. Establishing a local advisory board with strong representation from actualfarmers is a logical approach to ensure that health services are responsive to thecommunity’s needs on an ongoing basis. The Public Health Practice Program Office, adepartment within the CDC, has published a resource guide entitled Principles ofCommunity Engagement. Protocols detailed in the guide can be used to engage theagricultural community in the planning process.

Natalie Roy, MPHBusiness and Development DirectorAgriSafe Networkwww.agrisafe.org


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Glossary

Accident (Note: The term accident is not used by injury specialists and thus is not used in this document.) Anunexpected and undesirable event that occurs by chance. Injuries are not accidents. “If injuries were indeed random,unpredictable acts of God, it would make little sense to talk about preventing them (other than through prayer). Butinjuries can be scientifically understood and societally controlled by modifying physical agents, environments, andbehaviors. Rational counter-measures can be developed . . . injuries are preventable” (Foege WH: Introduction: InjuriesAre Not Accidents. Law, Medicine & Health Care [17]:5, Spring 1989).

Adolescent For purposes of this document, an individual between the ages of 13 and 17 years.

Adolescent farmworker For this report, an adolescent farmworker is defined as a child from 12 to 17 yearsold who migrates to work in agriculture in one or more states, or as a child who works locally in seasonal agriculturalbut does not leave his or her permanent residence.

Age-appropriate work Work activities that are suitable based on physical and cognitive capabilities deemed tobe typical of a particular age group. Age-appropriate work standards are required for purposes of labor lawenforcement.

Agricultural employer Any person, corporation, association, or other legal entity that owns or operates anagricultural establishment, contracts with the owner or operator of an agricultural establishment in advance of productionfor the purchase of a crop and exercises substantial control over production, or recruits and supervises employees or isresponsible for the management and condition of an agricultural establishment (OSHA 29 CFR 1928.110).

Agricultural hazard An existing or potential condition on or off the agricultural worksite, directly related toagricultural operations, that is associated with a high risk of physical or psychological harm. Examples of commonagricultural hazards are rotating machinery parts, manure storage ponds, airborne contaminants in livestockconfinement buildings, and chemicals.

Agricultural injury An injury occurring on the agricultural worksite directly related to agricultural operations, oran injury occurring off agricultural property that involves agricultural work, such as a tractor collision on a publicroad or in migrant housing. For purposes of this document, this definition also encompasses harm caused by exposureto hazards such as pesticides, volatile organic compounds, dusts, noise, and repetitive motion.

Agriculture The industry that involves the production of crops and livestock (farming) plus related services,forestry (excluding logging), and fishing.

Agromedicine A partnership of health and agricultural professionals that promotes the health and safety ofagricultural producers and workers, their families, and consumers of agricultural products. Agromedicine addresses thehealth and safety concerns of agriculture, including forestry and fisheries, by a combination of the sciences of agriculture andmedicine. This approach was established as a collaboration of the colleges of agriculture and schools of medicine and theirpartners.

The scope of agromedicine reaches all who are part of the universe relating to the practices or agents used by orproducts of the agricultural, forestry, and fishing industries. This comprehensive approach involves multiple disciplines.Examples of areas of agromedicine include agricultural chemicals (safety, toxicity, oncology, teratology, etc.), noise-induced hearing loss, skin cancer, farm stress, insect-transmitted disease, and other areas of preventive, occupational,and environmental medicine, rural health, and primary care. (NAAC)

Barrier A real or perceived physical, psychological, or environmental factor that hinders or restricts a person’sactions. Examples include economic hardship, tradition, cultural beliefs, and weather.

Best work practices Methods of making effective use of available experiences, systems, and resources, adaptedand validated in specific agricultural contexts, with the goal of providing an optimal environment in performing anyagricultural task, solving a work-related problem, improving a process, or actively managing a change. This definitionincludes two elements fundamental to the adoption of a best practice: a repository of experience with which to search


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Editor’s Note: In an effort to provide a modicum of consistency with other publications, as many words as possible retain thedefinitions used in Lee et al. (2002) and/or Vela Acosta & Lee (2001). The remainder are defined specifically for use in this document.

for and analyze candidate practices, and an adoption process to identify a method for their adaptation andimplementation in a specific agricultural context.

Children Individuals in the age range of 1 through 12 years.

Cumulative trauma Bodily injury from mechanical stress that develops gradually over weeks, months, or yearsfrom repeated stress on a particular body part.

Developmentally appropriate tasks Tasks that are suitable based on demarcations noting achievement ofphysical and psychological maturity. Developmentally appropriate task guidelines are applicable outside of enforcedwork standards.

Effectiveness The improvement in health outcome that a prevention strategy can produce in a typical community-based setting.

Engineering controls Methods of controlling worker exposure by modifying the source of or means of exposureto hazards, or by reducing their quantity.

Ergonomics The study of human characteristics for the appropriate design of living and working environments.

Exposure Contact with a chemical, biological, or radiological hazard; also, the close proximity to an unprotectedphysical hazard.

Family farm An operating entity owned and operated by a family or extended family that is directly involved inthe work and the necessary decision making for, and that derives a portion of their income from, crop or animalproduction.

Farm Any place from which $1000 or more of agricultural products were produced and sold, or normally wouldhave been sold, during the census year (standard U.S. Department of Agriculture definition).

Farm labor contractor A person (other than an agricultural employer, an agricultural association, or anemployee of an agricultural employer or agricultural association) who receives a fee for performing farm laborcontracting activities.

Farm worker A person who is employed by a farm owner to conduct agricultural work. This term includes thosewho are employed full-time, part-time, or seasonally, and who may or may not migrate. However, these individuals areexclusive of those identified as farmworkers, migrant farmworkers, and seasonal farmworkers.

Farmworkers A diverse population, whose composition varies from region to region. However, it is estimated that85% of all migrant workers are minorities, of whom most are Hispanic (including Mexican-Americans as well asMexicans, Puerto Ricans, Cubans, and workers from Central and South America). The migrant population alsoincludes black Americans, Jamaicans, Haitians, Laotians, Thais, and other racial and ethnic minorities. (NationalCenter for Farmworker Health, Inc.)

Fieldwork Work related to planting, cultivating, or harvesting operations (which occurs in the field rather than in aprocessing plant or packing shed).

H2A Guestworker Program [Labor Certification Process for Temporary Agricultural Employment in the UnitedStates (H-2A Workers)]

20 CFR 655.90—Scope and purpose of subpart B.

Section Number: 655.90, Section Name: Scope and purpose of subpart B.

(a) General. This subpart sets out the procedures established by the Secretary of Labor to acquire informationsufficient to make factual determinations of:

(1) Whether there are sufficient able, willing, and qualified U.S. workers available to perform the temporaryand seasonal agricultural employment for which an employer desires to import nonimmigrant foreign workers(H-2A workers); and

(2) whether the employment of H-2A workers will adversely affect the wages and working conditions ofworkers in the United States similarly employed. Under the authority of the INA, the Secretary of Labor haspromulgated the regulations in this subpart. This subpart sets forth the requirements and procedures


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applicable to requests for certification by employers seeking the services of temporary foreign workers inagriculture.

This subpart provides the Secretary’s methodology for the twofold determination of availability of domesticworkers and of any adverse effect which would be occasioned by the use of foreign workers, for particulartemporary and seasonal agricultural jobs in the United States.

(b) The statutory standard. (1) A petitioner for H-2A workers must apply to the Secretary of Labor for acertification that, as stated in the INA (Immigration and Nationality Act, addition for clarification):

(A) there are not sufficient workers who are able, willing, and qualified, and who will be available at thetime and place needed, to perform the labor or services involved in the petition, and

(B) the employment of the alien in such labor or services will not adversely affect the wages and workingconditions of workers in the United States similarly employed. (U. S. Department of Labor)

Hazard A condition or changing set of circumstances that presents a potential for injury, illness, or propertydamage. The potential or inherent characteristics of an activity, condition, or circumstance that can produce adverseand harmful consequences.

Health A state of complete physical, mental, and social well-being, and not merely the absence of disease orinfirmity (World Health Organization).

Health disparity A gap in the health status of different groups of people, in which one group is healthier than theother group or groups. Healthy People 2010 has two primary goals: (1) to increase the quality and years of healthy lifeand (2) to eliminate health disparities. These two goals are supported by 467 objectives in 28 focus areas. (For details,see www.health.gov/healthypeople/document/tableofcontents.htm)

Incentive A reward or punishment that induces action.

Injury Physical harm or damage to some part of the body resulting from an exchange of mechanical, chemical,thermal, electrical, or other environmental energy that exceeds the body’s tolerance.

Injury control Incorporates multiple activities to reduce severity of injury, including prevention, treatment, andrehabilitation.

Injury prevention Attempts to reduce the incidence of injury, usually by educational, engineering, environmental,and enforcement interventions.

Migrant farmworker A farmworker who is required to be absent overnight from his or her permanent place ofresidence.

Occupational health An area concerned with health in its relation to work and the working environment;including studies of all factors relating to work, working methods, conditions of work, and the working environmentthat may cause disease, injury, or deviation from health.

Permissible Exposure Limits (PELs) Guidelines limiting the amount or concentration of a substance in theair. They may also contain a skin designation. PELs are enforceable. OSHA PELs are based on an eight-hour time-weighted average (TWA) exposure. Employers who use regulated substances must control exposures to be below thePELs for those substances. Exposure limits usually represent the maximum amount (concentration) of a chemical thatcan be present in the air without presenting a health hazard. However, exposure limits may not always be completelyprotective.

Personal protective equipment (PPE) Clothing, devices, or solutions worn by or applied to an individualto serve as a barrier between the human body and potential hazards in the environment. Commonly used forms of PPEin agriculture include hats, long-sleeve shirts, long pants, gloves, safety goggles, sunscreen, ear plugs, and masks.

Primary care providers A term referring to physicians, physician assistants, and nurse practitioners.


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Production agriculture A term used to replace farming since it has broader application to the wide range ofcomplex machinery, sophisticated crop and livestock management practices, and relationships with associatedagricultural businesses.

Recommended Exposure Limits (RELs) Acting under the authority of the Occupational Safety and HealthAct of 1970 (29 USC Chapter 15) and the Federal Mine Safety and Health Act of 1977 (30 USC Chapter 22), NIOSHdevelops and periodically revises RELs for hazardous substances or conditions in the workplace. NIOSH alsorecommends appropriate preventive measures to reduce or eliminate the adverse health and safety effects of thesehazards. To formulate these recommendations, NIOSH evaluates all known and available medical, biological,engineering, chemical, trade, and other information relevant to the hazard. These recommendations are then publishedand transmitted to OSHA and the Mine Safety and Health Administration (MSHA) for use in promulgating legalstandards. (NIOSH)

Risk A measure of the probability and consequences of all hazards associated with an activity or condition.

Rural area The Census Bureau’s classification of “rural” consists of all territory, population, and housing unitslocated outside of urbanized areas (UAs) and urban clusters (UCs). The rural component contains both place andnonplace territory. Geographic entities, such as census tracts, counties, metropolitan areas, and the territory outsidemetropolitan areas, often are “split” between urban and rural territory, and the population and housing units theycontain often are partly classified as urban and partly classified as rural.

For Census 2000, the Census Bureau classifies as “urban” all territory, population, and housing units located within aUA or UC. It delineates UA and UC boundaries to encompass densely settled territory, which consists of:

• Core census block groups or blocks that have a population density of at least 1000 people per square mile

• Surrounding census blocks that have an overall density of at least 500 people per square mile

In addition, under certain conditions, less densely settled territory may be part of a UA or UC. (United States CensusBureau)

Safe Free from danger, hazard, or injury.

Safety A state of control of recognized hazards to attain an acceptable level of risk; also, an attitude that influencesbehavior of individuals in a positive manner in their relationships with others, in doing routine tasks and in reactionsto situations that may occur.

Safety program Activities designed to assist employees in the recognition, understanding, and control of hazardsin the workplace.

Seasonal farmworker A person employed in agricultural work of a seasonal or other temporary nature who isnot required to be absent overnight from his or her permanent place of residence.

Stress A physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in diseasecausation or fatigue.

Toxin Any poisonous substance (or any poisonous isomer, homologue, or derivative of such a substance), regardlessof its origin or method of production.

Undocumented farmworkers Farmworkers who enter the country illegally; that is, they do not possess thedocumentation necessary to be admitted to the United States under the following guidelines:

Under authority granted by the INA, as amended, an immigration inspector may question any person cominginto the United States to determine his or her admissibility. In addition, an inspector has authority to searchwithout warrant the person and effects of any person seeking admission, if there is reason to believe thatgrounds of exclusion exist which may be disclosed by such search. The INA is based on the law ofpresumption—an applicant for admission is presumed to be an alien until he or she shows evidence ofcitizenship, and an alien is presumed to be an immigrant until he or she proves that he or she fits into one ofthe nonimmigrant classifications. (U.S. Department of Justice)


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References

Conference Presentations and PapersThe following is a complete list of citations taken from the electronic proceedings of the Agricultural Safety and HealthNetwork’s “An Agricultural Safety and Health Conference: Using Past and Present to Map Future Actions,” Baltimore,March 1–2, 2001 (http://www.uic.edu/sph/glakes/agsafety2001/). Citations used in the preparation of this documentappear with the last name of the first author listed in parentheses with no date, for example, (Chapman).

Buchan, V., & Tungate, S. Future success: What is required? (Speaking on behalf of HI-CAHS/Agricultural CentersEvaluation Team.)

Buitrago, C. Farm population, migration, and its implications on health and safety: An anthropological approach.Chapman, L., & Meyers, J. Ergonomics and musculoskeletal injuries in agriculture.Cole, H.P. Cognitive-behavioral approaches to community safety education.Donham, K.J., & Storm, J.F. History of agriculture at risk: A report to the nation.Duarte, M., & Quavez, A.J. (translation). Farmworker responses to conference. (Speaking on behalf of Lideras

Campesinas and Centro Independiente de Trabjodores Agricolas.)Earle-Richardson, G. Agricultural health and safety among minority populations.Erisman, G. (a) Rural emergency response: The safety and health safety net.———. (b) Training of agricultural safety and health specialists: Academic preparation and inservice of agricultural

safety and health specialists/engineers.Felzien, J. Perspective from women involved in farm economics.Field, W.E., Yoder, A., & Kingman, D. Influences of disabling conditions on the nature and frequency of farm/ranch-

related injuries.Fuortes, L.G., Reynolds, S., & Tadevosyan, A. Review of acute and chronic health effects of common agricultural

insecticides.Griffin, D.L. Community intervention strategies: Insurance/other rebate initiatives.Gunderson, P. Overview of operational structure and potential changes. Hard, D.L., Myers, J.R., & Gerberich, S.G. Traumatic injuries in agriculture.Haynie, P. III. Perspective from the National Black Farmer’s Organization.Hernandez-Peck, M.C. Older farmers: Factors affecting their health and safety.Jones, P., & Field, W.E. Amish and other old order Anabaptists.Kirkhorn, S.R., & Schenker, M. Human health effects of agriculture: Physical diseases and illness.Lee, B.C., & Marlenga, B.L. Children in agriculture: Health and safety update.Lehtola, C.J., & Karsky, T. Agricultural occupational health services and delivery: Alternative strategies to deliver

distance learning.Lighthall, D. Occupational safety and health among California farm workers: Results of a statewide study.Mandelbaum, R. Building a just and humane food system through collaborative efforts.McCarthy, B. Environmental health: Overview of air, water, soil.McCoy, C.A., Carruth, A.K., & Reed, D.B. Women in agriculture: Risks for occupational injury within the contexts of

role and Haddon’s Injury Model.Myers, M.L. Tractor risk abatement and control.Niedda, T., & Flocks, J. Facing the challenges of agricultural technology and its impact on health.Palermo, T., Ehlers, J., & Jones, S. Coalitions: Building partnerships to promote agricultural health and safety.Rautiainen, R.H. Incentive based intervention programs in agriculture.Rautiainen, R.H., & DeRoo, L.A. Effectiveness of farm safety interventions.Rautiainen, R.H., & Reynolds, S.J.. Mortality and morbidity in agriculture in the United States.Redding, L. Engineering and technology: machinery.Rosmann, M.R. Agricultural mental health.Runyan, J.L. Federal laws and regulations affecting farm safety.Shutske, J.M. The impact of biotechnology and information technology on agricultural worker safety and health.Stallones, L. Health and safety issues among non-migrant adult farm workers.Steffen, D. Engineering and technology: buildings and structures.Thu, K.M. Neighbor health and large-scale swine production.Vela Acosta, M.S. Migrant and seasonal adolescent farmworkers: New challenges.


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Von Essen, S., & Romberger, D. The respiratory inflammatory response to the swine confinement buildingenvironment.

Weyer, P. Nitrate in drinking water and human health.Wheat, J.R., Donham, K.J., Simpson, W.M., Roy, N., & Kirkhorn, S. Medical education for agricultural health and safety.Willkomm, T. Farming and ranching with a disability.Work groups. This citation refers to discussion items or references to specific programs or literature that arose during

the individual work-group discussions, comments on compiled work-group summaries, or the collectivediscussions during the closing face-to-face work-group meeting.

Other Citations These citations either provide for processes or initiatives used as a base for the current project or are referred to inbackground information underlying recommendations and rationales derived from specific presentations or work-group processes. The citations, particularly World Wide Web sites, provide the most current listings found.

Accreditation Board for Engineering and Technology, Inc. (ABET) (2003). Available at: http://www.abet.org/accredited_prgs.html.

Birkett, J.W., & Lester, J.N. (eds.). (2003). Endocrine disruptors in wastewater and sludge treatment processes. BocaRaton, FL: CRC Press.

Bureau of Labor Statistics (BLS). (2003). Census of Fatal Occupational Injuries summary. Available at:http://stats.bls.gov/news.release/cfoi.nr0.htm. BLS is an agency of the U.S. Department of Labor.

California Department of Pesticide Regulation (CDPR). (2003a). Progress report 2002. Available at:http://www.cdpr.ca.gov/docs/progress_reports/2002/pdf_files/entire.pdf.

———. (2003b). Laws & Regulations: Food and Agriculture Code, Divisions 6, 7, 13. Available at:http://www.cdpr.ca.gov/docs/legbills/opramenu.htm.

Delbecq, A., Van de Ven, A., & Gustafson, D. (1975). Group techniques for program planning. Glenview, IL: Scott,Foresman.

Donham, K., Osterberg, D., Myers, M., & Letohla, C. (1997). Tractor risk abatement and control: The policyconference, Sept. 10–12, final report. Iowa City: University of Iowa.

Donham, K.J., & Storm, J.F. (2002). Agriculture at Risk: A Report to the Nation—A historical review, critical analysis,and implications for future funding. Journal of Agriculture Safety and Health 8(1), 9–35.

Erisman, G. (2003). Personal communications.Health Resources and Services Administration (HRSA). (2003). Bureaus. Available at: http://www.hrsa.gov/.Institute of Medicine of the National Academies (IOM). (1988). Future of public health. Washington, DC: National

Academy Press.Iowa Center for Agricultural Safety and Health (ICASH). (2003). Available at:http://www.public-health.uiowa.edu/ICASH/PROGS.HTM.Lee, B., Gallagher, S., Marlenga, B., & Hard, D. (eds.). (2002). Childhood agricultural injury prevention: Progress

report and updated national action plan from the 2001 summit. Marshfield, WI: Marshfield Clinic.Merchant, J.A., Kross, B.C., Donham, K.J., & Pratt, D.S. (eds.). (1989). Agriculture at risk: A report to the nation.

The National Coalition for Agricultural Safety and Health. Iowa City: University of Iowa, Institute ofAgricultural Medicine and Occupational Health.

National Advisory Committee on Rural Health and Human Services (NACRHHS). (2003). Available at:http://ruralcommittee.hrsa.gov/. A committee of the Office of Rural Health Policy/Health Resources and ServicesAdministration within the Department of Health and Human Services.

National Cancer Institute (NCI). (2003a). Pesticide: Word search. Results posted at: http://plan.cancer.gov/cgi-bin/ospasearch.pl?exclude=&config=2004bypass&restrict=http%3A%2F%2Fplan.cancer.gov

&words=Pesticides.———. (2003b). Nitrates: Word search. Results posted at: http://plan.cancer.gov/cgi-

bin/ospasearch.pl?config=2004bypass&restrict=http%3A%2F%2Fplan.cancer.gov&exclude=&page=&pgcrp=&pgnci=&pgbypass=&words=Nitrates.

National Center for Farmworker Health, Inc. (NCFH). (2003). Overview of America’s farmworkers. Available at:http://www.ncfh.org/aaf_01.shtml.

National Highway Traffic Safety Administration (NHTSA) (2003a). Who are we? Available at:http://www.nhtsa.dot.gov/nhtsa/whatis/overview/. NHTSA is an agency of the Department of Transportation.

———. (2003b). Highway Safety Act of 1966, 1998 Revision. Available at:http://www.nhtsa.dot.gov/nhtsa/whatsup/tea21/GrantMan/HTML/07_Sect402Leg23USC_Chap4.html.


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National Institute for Farm Safety (NIFS). (2003a). Mission statement. Available at: http://www.ag.ohio-state.edu/~agsafety/NIFS/nifs.htm.

———. (2003b). Publications, NIFS papers and presentations by category, Education/Programming. Applicable papersfrom the cited states presented at the 1992 NIFS Summer Conference. Titles available at: http://www.ag.ohio-state.edu/~agsafety/NIFS/cat2.html#Education.

National Institute for Occupational Safety and Health (NIOSH). (2003a) NIOSH pocket guide to chemical hazards.Available at: http://www.cdc.gov/niosh/npg/pgintrod.html. NIOSH is an institute of the Centers for DiseaseControl and Prevention, U.S. Department of Health and Human Services.

———. (2003b). Centers for Agricultural Disease and Injury Research, Education, and Prevention RFA: OH-03-002.Available at: http://grants1.nih.gov/grants/guide/rfa-files/RFA-OH-03-002.html.

———. (2003c). NIOSH Education and Research Centers. Available at: http://www.cdc.gov/niosh/training.html.———. (2003d). NIOSH Sentinel Event Notification System for Occupational Risks (SENSOR). Available at:

http://www.cdc.gov/niosh/frn708.html.National Occupational Research Agenda (NORA). (2003). Priority research areas. Available at:

http://www2.cdc.gov/NORA/default.html.NCR-197 Committee on Agricultural Safety and Health Research and Extension. (2003). National land grant research

and extension agenda for agricultural safety and health—2003. Cooperative State Research, Education, andExtension Service, U.S. Department of Agriculture.

North American Agromedicine Consortium (NAAC). (2003). About the North American Agromedicine Consortium.Available at: http://www.agromedicine.org/NAAC%20Brochure.htm.

Occupational Health and Safety Administration (OSHA). (2003). Safety and health topics: Permissible Exposure Limits.Available at: http://www.osha.gov/SLTC/pel/index.html. OSHA is an agency of the U.S. Department of Labor.

Office of Disease Prevention and Health Promotion. (2003a). Healthy People 2010 and environmental health.Available at: http://www.healthypeople.gov/Document/HTML/Volume1/08Environmental.htm. An agency of theU.S. Department of Health and Human Services.

———. (2003b). Disability and secondary conditions. Available at:http://www.healthypeople.gov/Document/HTML/Volume1/06Disability.htm.

Office of Rural Mental Health Research. (2003). Available at: http://www.nimh.nih.gov/ormhr/index.htm. An agencyof the U.S. Department of Health and Human Services.

Purdue University. (1997). The childhood agricultural injury prevention strategy workshop: A private sectorperspective. Final report: A summary of strategies and successes. West Lafayette, IN: Purdue University,Agricultural Safety and Health Program.

Skjolaas, C.A. (2003). Personal communications.United States Department of Agriculture. (USDA) (2000). Meeting the challenge of A Time to Act: USDA Progress and

Achievements on Small Farms report. Available at: http://www.usda.gov/oce/smallfarm/reports/rpt1forw.htm.United States Department of Agriculture, Animal and Plant Health Inspection Service (USDA APHIS). (2003).

Agricultural bioterrorsim. Available at: http://www.aphis.usda.gov/ppq/permits/agr_bioterrorism/.United States Department of Agriculture, Cooperative State Research, Education, and Extension Service (USDA

CSREES). (2003). Learn about CSREES. Available at: http://www.reeusda.gov/1700/about/about_csrees.htm.United States Department of Commerce, U.S. Census Bureau. (2003). Census 2000 urban and rural classification.

Available at: http://landview.census.gov/geo/www/ua/ua_2k.html.United States Department of Health and Human Services (USDHHS). (1995). Ten essentials of public health services.

Washington, DC: Government Printing Office.United States Department of Homeland Security (USDHS). (2003). DHS organization. Available at:

http://www.dhs.gov/dhspublic/theme_home1.jsp.United States Department of Justice. (2003). U.S. Immigration and Naturalization Service. Available at:

http://ojjdp.ncjrs.org/pubs/fedresources/ag-10.html.United States Department of Labor (2003). Labor Certification Process for Temporary Agricultural Employment in the

United States (H-2A Workers), Subpart B. Available at: http://www.dol.gov/dol/allcfr/Title_20/Part_655/20CFR655.90.htm.

United States Environmental Protection Agency (USEPA). (2003). About EPA. Available at:http://www.epa.gov/epahome/aboutepa.htm.

Universal Design Education Online. (2003). About this site. Available at: http://www.udeducation.org/about/index.aspVela Acosta, M.S., & Lee, B. (eds.). (2001). Migrant and seasonal hired adolescent farmworkers: A plan to improve

working conditions. Marshfield, WI: Marshfield Clinic.Wilson, S.H., & Suk, W.A. (eds.). (2002). Biomarkers of environmentally associated disease: Technologies, concepts,

and perspectives. Boca Raton, FL: CRC Press.Woodward, M. (1999). Epidemiology: Study design and data analysis. Boca Raton, FL: CRC Press.


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Healthy People 2010

The leading health indicators are:• Physical Activity • Mental Health • Overweight and Obesity • Injury and Violence • Tobacco Use • Environmental Quality • Substance Abuse • Immunization • Responsible Sexual Behavior • Access to Health Care

The 28 focus areas are:1. Access to Quality Health Services 15. Injury and Violence Prevention2. Arthritis, Osteoporosis, and Chronic Back Conditions 16. Maternal, Infant, and Child Health3. Cancer 17. Medical Product Safety4. Chronic Kidney Disease 18. Mental Health and Mental Disorders5. Diabetes 19. Nutrition and Overweight6. Disability and Secondary Conditions 20. Occupational Safety and Health7. Educational and Community-Based Programs 21. Oral Health8. Environmental Health 22. Physical Activity and Fitness9. Family Planning 23. Public Health Infrastructure

10. Food Safety 24. Respiratory Diseases11. Health Communication 25. Sexually Transmitted Diseases12. Heart Disease and Stroke 26. Substance Abuse13. HIV 27. Tobacco Use14. Immunization and Infectious Diseases 28. Vision and Hearing

National Occupational Research Agenda Priority Research Areas

Disease and InjuryAllergic and Irritant DermatitisAsthma and Chronic Obstructive Pulmonary Disease

Fertility and Pregnancy AbnormalitiesHearing LossInfectious DiseasesLow Back DisordersMusculoskeletal Disorders of the Upper Extremities

Traumatic Injuries

Work Environment and WorkforceEmerging TechnologiesIndoor EnvironmentMixed ExposuresOrganization of WorkSpecial Populations at Risk


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Research Tools and ApproachesCancer Research MethodsControl Technology and Personal Protective Equipment

Exposure Assessment MethodsHealth Services Research Intervention Effectiveness ResearchRisk Assessment MethodsSocial and Economic Consequences of Workplace Illnessand Injury

Surveillance Research Methods

Appendix

Conference Summary“An Agricultural Safety and Health Conference: Using Past and Present to Map Future Actions” was held in Baltimore,Maryland, on March 2–3, 2001. Specific conference objectives were to:

1. Facilitate the presentation of diverse opinions regarding the current status of agricultural safety and health.

2. Provide a forum for discussions on the future research, education, training, and programming needs of agriculturalsafety and health.

3. Afford practicing farmers, farmworkers, their families, and their respective organizations an opportunity to givetheir opinions on and their appraisal of the agricultural safety and health environment in which they work.

4. Foster the development of recommendations on future agricultural safety and health policy by laying a foundationof information and opinion upon which to build those recommendations.

The conference attracted 165 registered participants. These participants included 26 practicing farmers. These farmersrepresented eight states from across the nation and were approximately 50% female. The participants also included 25Latino practicing or former farmworkers. These farmworkers represented seven states, the three major migrantstreams, and were approximately 50% female. Other participants included federal and state agency personnel,university researchers and programming personnel, agricultural industry representatives, and health professionals of alllevels. Simultaneous English to Spanish oral translation was provided for the Spanish-speaking participants as needed.In addition, a Spanish-language version of the program was provided.

Over the 1/2-day conference, 7 presentations were made in the general sessions and 34 presentations were made in theconcurrent sessions. These presentations were grouped under the nine arbitrary general topics of:

• Farm Populations (including NORA Special Populations)• Hired Labor• Public Policy• Engineering and Technology• Community Strategies• Environmental Health• Training of Agricultural Safety and Health Specialists• Human Health (Mental and Physical)• Agricultural Occupational Health Services and Delivery

Conference speakers were asked for their perceptions of the investments and key activities in agricultural safety andhealth during the period 1987 through 2001 that corresponded to their specific topic. Conference speakers were alsoasked to identify current gaps that remain in need of research and intervention. In addition, the speakers were asked tolook to the future and anticipate changes that might impact that topic. Finally, speakers were asked for specificrecommendations for future programs and policy, based on their presentation content.

As a result of conference presentations and discussions, farmworker participants asked for, and were granted, timeduring the final session to address the gathering with a general response to specific items brought forward during theconcurrent sessions.

Consensus Work-Group Process SummaryThe consensus work-group phase began immediately following the end of the conference, with nearly 100 conferenceparticipants. Participation in the six work groups included 15 farmers. These farmers were voluntarily spread amongthe five of the work groups to allow for farmer interaction with safety and health professionals. In addition, 16farmworkers met as a single group. This was done at their request. The farmworkers felt that meeting as a single group would be less threatening and also that the activity would be more efficient if conducted in Spanish, with no translation needed.


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The responses elicited from the on-site work-group participants would serve as the point of departure forteleconferences over the next year. The work-group participants were guided by a facilitator to maintain contact, leadwork-group teleconferences, and supply summaries of previous activities. These activities were necessary in order toreach consensus on key questions:

What are the current gaps, needs, and oversights in current activities related to agricultural safety and health?

What are your suggestions on how to address the current gaps, needs, and oversights in activities related to agriculturalsafety and health?

What do you see as the barriers to implementing your suggestions for addressing the current gaps, needs, andoversights in activities related to agricultural safety and health?

Following the initial consensus meeting held after the Baltimore conference, a series of teleconferences were held by thework groups to augment and refine the work begun at the initial meeting. The work groups remained as constitutedduring the initial meeting, that is, five work groups made up of a combination of farmers and others, and a sixth workgroup made up of farmworkers and that also included professionals working in that arena. Again, the farmworkersrequested a separate work group to facilitate discussions, held in Spanish, and to preclude any perceived power issues.

A total of 12 facilitated teleconferences were held by the six work groups over the late summer and fall of 2001, withan average participation of six participants per call. Additional contacts with work-group participants were made usingU.S mail, electronic mail, and phone calls. Individual members of work groups who were unable to participate inspecific teleconferences were provided multiple opportunities to contribute. All work-group participants were suppliedwith updated response/discussion lists from all the other work groups.

The face-to-face meeting in St. Louis was held on February, 27, 2002. All participants in the work groups were invitedto this meeting. A total of 30 people attended the meeting—11 farmworkers, 10 farmers, and 9 “others”—all of whomattended the Baltimore conference. As with the conference, on-site oral English to Spanish and Spanish to Englishtranslations were provided along with Spanish translation of all text items.

The initial consensus meeting following the conference and the teleconferences provided the base of information use atthe St. Louis meeting. The time was devoted to a final review of responses to the three key questions, with the majorityof discussion centering on those items about which there were questions or disagreement. The important items ofdiscussion are summarized as follows:

1. Focus of document: Include as many items as possible while concentrating on those items that we thinkcan have an impact.

2. The face-to-face and teleconference meetings produced 13 pages of specific participant thoughts on thegaps and needs, suggestions to address the gaps and needs, and barriers related to current agriculturalsafety and health issues. The thoughts were organized for review under the nine arbitrary topics used forpresentations at the conference.

a. The majority of the gaps and needs are found within the Hired Workers and Human Health categories.

b. The majority of suggestions toaddress the gaps and needs arefound under the FarmPopulations, Hired Workers,Community Strategies, and PublicPolicy categories.

c. The majority of the barriers arefound under the Farm Populations,Hired Workers, CommunityStrategies, and Public Policycategories.


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All items contained in the summary listing will be included in the draft document as they can be within the primaryconsideration under item 1.

The following items merited special mention as they were among the items on which there were some questions ordisagreement and about which some accommodation was reached.

1. Emphasize that there are many specific agricultural safety and health concerns that overlap betweenfarmers and migrant/seasonal farmworkers but that there are also specific items that are unique tomigrant/seasonal farmworkers, and these need to be noted.

2. Form a committee including Chip Petrea and farmworker and advisory committee representatives todevelop a mutually acceptable farmer/farmworker identification scheme to include in recommendations.

3. Include piece written by Aspacio Alcantara on disadvantages of being an undocumented farmworker as acentral statement of the group’s plight.

4. Provide a prominent location, perhaps in a prologue, to state concerns related to the current H2A guestworker visa program.

5. Provide a prominent location for a recognition of the “power” issues, with a short explanation of howthese affect both the living and working environment of migrant/seasonal farmworkers.

6. Include of a piece written by a family farm operator describing the perception of the difficulties theseindividuals face.

7. Recognition that many part-time and seasonal workers on farms accept certain inherent working conditionsand responsibilities within the workplace because these are the same ones that apply to thefarmer/owner/employer.

8. Emphasize the need for better awareness among and training of health professionals on commonmigrant/seasonal farmworker health issues.

9. Provide a short explanation of migrant/seasonal farmworker perspectives related to reporting requirementsof pesticide exposure incidents.

10. In the Health Professionals section, be specific on the need for more and better education of farmers,migrant/seasonal farmworkers, and their families, as well as rural residents, regarding potential exposuresto pesticides in their residences as well as at their worksites.

11. Disagreement item: The issue of universal health benefits for all workers was discussed. Farmworkers andtheir representatives favored such, while farmers contended that this was not a benefit routinely providedfor any part-time employee or even many full-time employees.

12. Related to item 13 was the potential inclusion within the document of the consensus of concern toward healthcare costs in general.

An additional work group, consisting of designated boardmembers from the National Institute for Farm Safety (NIFS) andthe North American Agromedicine Consortium, has been formedto discuss common issues of concern related to interaction andcross-training of individuals serving in safetyspecialist/extension/engineer capacities and those serving in thehealth and medical professions. There is long-standingcollaboration between individuals within the two groups, butidentification of specific common concerns, identification ofpotential outcomes, and recommendations related to thoseconcerns is deemed useful. While there were some pertinentitems identified in the other work groups, a specific work groupon the topic could not only generate potential items for use inthe upcoming document but also could contribute to furtherinteraction between the two organizations and their members.


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Documents

Using History and Accomplishments to Plan for the Future